Das maligne Pleuramesotheliom

 

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Zusammenfassung

Das maligne Pleuramesotheliom (MPM) ist ein bösartiger und sehr aggressiver Tumor, der seinen Ursprung in den mesothelialen Oberflächen der Pleura nimmt. Die Hauptursache des MPM ist die Inhalationsexposition gegenüber Asbest. Hier kann die Latenzzeit jedoch 30–60 Jahre betragen. Die klinischen Symptome sind meist unspezifisch. Die Diagnosestellung eines MPM sollte mittels adäquater Gewebegewinnung erfolgen. Die beste Aussagekraft zeigt hier die diagnostische Videothorakoskopie (VATS). MPM werden hauptsächlich in epitheloide, sarkomatoide und biphasische (gemischte) Subgruppen unterteilt. Vor der interdisziplinären Festlegung eines multimodalen Therapieregimes ist ein dezidiertes, u. U. auch invasives Staging erforderlich. Eine multimodale Therapie ist – falls sich der Patient hierfür funktionell und onkologisch qualifiziert – allen anderen Monotherapien überlegen. Das Ziel der chirurgischen Therapie ist die makroskopisch komplette Resektion des Tumors. Grundsätzlich stehen in der operativen Behandlung des MPM 2 verschiedene, konkurrierende Resektionsphilosophien zur Verfügung: die extrapleurale Pneumonektomie (EPP) und die radikale Pleurektomie (RP). Ein Paradigmenwechsel hat in den letzten Jahren stattgefunden: RP ist die inzwischen präferierte Resektionsbehandlung geworden.

Abstract

Malignant pleural mesotheliomas (MPM) are very aggressive tumors, which originate from the mesothelial cells of the pleural surface. The main risk factor associated with MPM is exposure to asbestos. The latency period between asbestos exposure and MPM can be 30–60 years. Clinical symptoms and signs are often nonspecifc. The diagnosis of MPM requires an adequate tissue specimen for pathological examination, and video assisted thoracoscopic surgey (VATS) is associated with the highest diagnostic yield. MPM are histologically classified into epitheloid, sacromatoid and biphasic (mixed) sub-types. Accurate staging with invasive tests, if needed, is an important step before an interdisciplinary team can decide on an optimal (multi-modal) treatment approach. A multi-modal treatment approach (surgery, radiation oncology and chemotherapy) is superior to all approaches relying only on a single modality, if the patient qualifies for it from an oncological and functional standpoint. The goal of the surgical therapy is to achieve macroscopic complete resection. There are two competing surgical approaches and philosophies: extrapleural pneumonectomy (EPP) and radical pleurectomy (RP). Over the last years a paradigm shift from EPP to RP occurred and RP is now often the preferred surgical option.

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