Chest
Volume 116, Issue 2, August 1999, Pages 504-520
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Reviews
Advances in the Treatment of Malignant Pleural Mesothelioma

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Malignant pleural mesothelioma is a neoplasm that is commonly fatal and for which there are no widely accepted curative approaches. Mesothelioma is unresponsive to most chemotherapy and radiotherapy regimens, and it typically recurs even after the most aggressive attempts at surgical resection. Multimodality approaches have been of some benefit in prolonging survival of very highly selected subgroups of patients, but they have had a relatively small impact on the majority of the patients diagnosed with this disease. As the incidence of pleural mesothelioma peaks in the United States and Europe over the next 10 to 20 years, new therapeutic measures will be necessary. This review will discuss the roles of chemotherapy, radiotherapy, surgery, and combined modality approaches in the treatment of pleural mesothelioma, as well as scientific advances made in the past decade that have led to the development of experimental techniques, such as photodynamic therapy, immunotherapy, and gene therapy, that are currently undergoing human clinical trials. These promising new avenues may modify the therapeutic nihilism that is rampant among clinicians dealing with mesothelioma.

Key words

chemotherapy
extrapleural pneumonectomy
gene therapy
immunotherapy
mesothelioma
photodynamic therapy
pleurectomy
pleurodesis
pneumonectomy
radiation

Abbreviations

Ad.HSVtk
replication-deficient adenovirus encodingherpes simplex thymidine kinase
EPP
extrapleuralpneumonectomy
18-FDG
18-fluoro-2-deoxyglucose
GCV
ganciclovir
GM-CSF
granulocyte-macrophagecolony-stimulating factor
Hp D
hematoporphyrin derivative
HSVtk
herpes simplex thymidine kinase
IFN
interferon
IL
interleukin
LAK
lymphokine-activatedkiller
m-THPC
meta-tetrahydroxyl phenylchlorin
PA1-STK
ovarian carcinoma cell line retrovirally transfected with HSVtk
PCR
polymerase chain reaction
PDT
photodynamic therapy
PET
positron emission tomography
pfu
plaque-forming unit
TGF-β
transforming growthfactor-β
VV
vaccinia virus

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