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**Chapter 5** 

© 2012 Pasello and Favaretto, licensee InTech. This is an open access chapter distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2012 Pasello and Favaretto, licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

**Neoadjuvant Chemotherapy in** 

Giulia Pasello and Adolfo Favaretto

http://dx.doi.org/10.5772/47880

**1. Introduction** 

(Marinaccio et al., 2007).

Vogelzang et al., 2003).

Additional information is available at the end of the chapter

**Malignant Pleural Mesothelioma** 

Malignant pleural mesothelioma (MPM) is a rare and aggressive tumour with a poor prognosis, directly related to chronic inhalation of asbestos fibres. Despite the extraction, import and marketing of the mineral were banned in most of the industrialized nations, the epidemiologic data foresee a sharp rise of MPM incidence and mortality in the next fifteen years because of the long lag time (even 40 years) from exposure to clinical evidence

Malignant mesothelioma is usually diagnosed in the advanced stages and single-modality treatment generally did not achieve higher results than supportive care. MPM shows high refractoriety to systemic treatment, and the response rate in previous series was about 10%-

Doublet chemotherapy showed similar results, even though some combinations yielded higher response rates than single agents. Responses are of short duration and complete responses are rarely observed. Currently available chemotherapy regimens achieved a response rate of 30-40% with rare complete responses, a median progression free and overall survival of approximately 6 and 12 months respectively (van Meerbeeck et al., 2005;

With regard to local treatments, radiotherapy to the entire hemithorax may cause life-

Extrapleural pneumonectomy (EPP), a surgical procedure introduced in the seventies which implies en bloc resection of the parietal pleurae, lung, ipsilateral pericardium and hemidiaphragm, did not improve the incidence of local and distant recurrences and that

20% with anthracyclines, antimetabolites, or single agents platinum analogs.

threatening pulmonary toxicity when the lung is not removed.

was the reason for some centres to perform combined treatments.


**Chapter 5** 
