general treatment approach to malignant pleural mesothelioma
Radical surgery (either radical pleurectomy-decortication or extrapleural pneumonectomy with removal of the pleura, mediastinal lymph nodes, ipsilateral pericardium, and diaphragm) is considered when there is tumor without lymphadenopathy. Radiotherapy, chemotherapy, and photodynamic therapy may also be used with surgery as adjuvant treatments. Talc pleurodesis or video-assisted thoracoscopic pleurectomy may also be used to control pleural effusions and are less invasive than open pleurectomy and decortication. Radiotherapy may be used palliatively to relieve pain in about 50% of cases or can be used prophylactically at biopsy sites to prevent seeding by tumor. Pain medications are used as needed.