Multimodality treatments in the management of malignant pleural mesothelioma: an update.

Malignant pleural mesothelioma (MPM) is relatively unique among cancers because the local and regional disease rather than the systemic disease usually contributes to death. Because of its multifocal distribution in the chest, MPM progresses locally by compressing the lung, heart, and major vessels and causes death by cardiac tamponade and lung collapse physiology. The therapy for this aggressive local malignancy is currently inadequate. In most cases there is no sufficient time for systemic disease to develop or contribute to mortality. The first order of therapy in MPM is currently, as it has been for decades, to control effectively the tumor's locoregional spread and then deal with controlling the distant disease.