Extrapleural pneumonectomy in malignant pleural mesothelioma

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d5706 (Published 13 September 2011) Cite this as: BMJ 2011;343:d5706
  1. Ottavio Rena, senior thoracic surgeon
  1. 1Thoracic Surgery Unit, University of Eastern Piedmont, I-28100 Novara, Italy
  1. ottaviorena{at}libero.it

Should be limited only to patients enrolled in trials, according to new trial evidence

The asbestos related cancer, malignant mesothelioma, is a major health problem worldwide. The European epidemic is expected to peak within the next decade, with about 250 000 deaths predicted, mostly from malignant pleural mesothelioma.1

Malignant pleural mesothelioma is a diffuse cancer that spreads along the pleura and causes breathlessness, severe chest pain, and cachexia. The search for curative and palliative treatments is ongoing. The tumour is radiation sensitive, but its pattern of growth (surrounding the lung, being close to the heart, spinal cord, and other organs; and its large surface area rather than localised bulk) makes it difficult to deliver sufficiently high doses without causing serious damage.2 Sensitivity to chemotherapy is moderate, but a higher tumour regression rate (about 40%) has been obtained by the use of cisplatin and pemetrexed combined.3

Over the past 20 years extrapleural pneumonectomy has been used to maximise the therapeutic effects of chemotherapy and radiotherapy. When …

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