Malignant pleural mesothelioma.

malignant pleural mesothelioma is a relatively uncommon disease associated with asbestos exposure. its incidence increased markedly following the widespread mining and use of asbestos in many industries. the legal aspects regarding compensation cases for those who have developed this disease has raised its profile in the media, but also compounds the stress of diagnosis for patients. it has an insidious onset and may clinically and pathologically mimic other benign or malignant processes, complicating diagnosis. radical surgery may be used for a highly selected population of malignant pleural mesothelioma patients in the context of multimodality treatment in an experienced thoracic surgical centre, but there is no randomised evidence to support its benefit. in most cases surgery is used to treat symptoms or obtain tissue for diagnosis. Combination of a platinum agent and pemetrexed is now widely used and shown to prolong life. other treatments including radiotherapy, analgesics and supportive interventions are an integral part of the treatment of this disease. Further research is being undertaken on promising novel therapies for use in this disease, which will be discussed in this review. malignant pleural mesothelioma (mpm) is a neoplasm originating from mesothelial cells, which form the membranes surrounding the lung cavities. it is currently a disease mainly of the industrialised world, closely linked to asbestos exposure.1 seldom diagnosed prior to the advent of widespread asbestos mining in the early to mid twentieth century, it has risen in incidence over the last five decades.2, 3 according to the most recent australian institute of health and Welfare data, in 2009 there were 666 cases of malignant mesothelioma diagnosed in australia.4 this review will provide a brief overview of the diagnosis, current treatment modalities and some novel systemic treatment strategies that have been explored in mpm. Asbestos and malignant mesothelioma mpm is a disease with particular relevance to australia. Asbestos was first mined in Australia in the 1880s near Jones Creek, a town in nsW.5 it was not until the late 1940s when the insulating properties of asbestos rendered it a useful product in the building industry during the post war building boom, and subsequent demand for asbestos saw mining production rise exponentially in mines in nsW, tasmania, south australia and Western australia.5 there has also been widespread exposure within the building and transport industries in which asbestos was broadly utilised.6 Asbestos mining ended in Australia in 1983, and it is expected that malignant mesothelioma related to occupational exposure will plateau in the coming decade. in a Western Australian study, however, a significant increase was noted in the number of people being diagnosed with malignant meosthelioma whose only exposure to asbestos must have occurred in a non-occupational setting (most likely during home maintenance and renovation). Between 2005 and 2008, 8% of males and 5% of females diagnosed with malignant mesothelioma in this series reported non-occupational exposure as their only exposure to asbestos.6 these observations ask for confirmation in a case-controlled epidemiological study.