ABSTRACT
Diffuse malignant pleural mesothelioma (DMPM) is a rare disease that presents several challenges to physicians. Two thousand to 3000 cases are expected annually in the United States (1), and the incidence is rising. As a result, physicians do not routinely encounter mesothelioma, and this poses difficulties in recognizing and diagnosing mesothelioma while it is still at an early stage. Hence, many patients are diagnosed too late, resulting in a quite short time period from diagnosis to demise. Surgery, chemotherapy, radiotherapy, and immunotherapy have been tried as single modalities or in various combinations as part of multimodality regimens. Treatment with a single modality has failed to prolong the 4-to 12-month median survival that matches the natural history of the disease (2). Multimodality regimens that incorporate surgery with other therapies, on the other hand, have resulted in prolonging median survival. It should be noted that even aggressive cytoreductive surgery such as extrapleural pneumonectomy should be considered in the setting of a multimodality regimen and offered to the appropriate subset of patients. Due to the lack of a universally accepted staging system and randomized controlled studies, however, debate continues as to whether extrapleural pneumonectomy is an appropriate cytoreductive procedure for DMPM.
