[Multimodal therapy for malignant pleural mesothelioma including extrapleural pneumonectomy].

Multimodal therapy including neoadjuvant chemotherapy with subsequent extrapleural pneumonectomy and postoperative radiotherapy has been shown to improve the survival of patients with malignant pleural mesothelioma (MPM) if they are selected carefully. Careful patient selection is required in order to administer aggressive multimodal therapy only to patients who will benefit from such a treatment. To achieve an accurate staging (<or= cT3, < pN2, cM0), mediastinoscopy is recommended in addition to computed tomography of the chest and upper abdomen. Currently, neoadjuvant chemotherapy with pemetrexed and cisplatin followed by extrapleural pneumonectomy and postoperative radiotherapy is claimed to afford the best treatment results. We have treated 17 patients with such a regimen and achieved a 3-year survival rate of 76 % so far. During the follow-up duration of 23 months, 3 patients (18 %) developed distant metastasis and one (6 %) a mediastinal local recurrence. Multimodal therapy of malignant pleural mesothelioma including extrapleural pneumonectomy should only be performed in specialised centres for thoracic surgery where uncomplicated interdisciplinary communication is the rule and which provide the required expertise in patient selection, operative technique and postoperative care.