Which of the following statements about therapy for malignant pleural mesothelioma is/are correct?

B. Extrapleural pneumonectomy involves resection en bloc of the lung, visceral and parietal pleura, pericardium, and diaphragm.

D. Neither surgery, chemotherapy, nor radiation therapy as a single therapy improves survival.

E. Multimodality therapy, combining surgery, chemotherapy, and radiation therapy may improve survival in select patients.

DISCUSSION: In debilitated patients, palliation by pleurodesis is indicated; however, cytoreductive techniques, including pleurectomy/decortication, and extrapleural pneumonectomy, are indicated for patients who can tolerate surgery. For Stage I disease, extrapleural pneumonectomy is offered. If the patient cannot tolerate pulmonary resection or if the lesion is unresectable by extrapleural pneumonectomy, pleurectomy/decortication is appropriate. Both cytoreductive procedures, when used in a multimodality setting, may improve survival in selected patients. They also improve quality of life by relieving or delaying two severe symptoms of mesothelioma: dyspnea secondary to lung restriction by the tumor and pain from tumor invasion. No single modality (surgery, chemotherapy, or radiation therapy) improves survival.