Each of the following statements regarding treatment of malignant mesothelioma is true EXCEPT: 

A. Chemotherapy has proven ineffective in this disease and is rarely indicated outside of a clinical trial.
B. Extrapleural pneumonectomy has been shown to be superior to other forms of treatment for the disease. 
C. Median survival is approximately 20 months after diagnosis regardless of the treatment offered. 
D. Pleurectomy for diagnosis and treatment followed by radiation therapy is acceptable treatment. 

Answer B

Malignant mesothelioma is an uncommon malignancy - - approximately 5000 new cases per year are seen in the United States. It is closely associated with asbestos exposure and has proven recalcitrant to essentially all attempts at treatment. Chemotherapy either with a single drug or with a combination of drugs has not been shown to have any impact on survival in this disease. Surgery alone ,whether pleurectomy or extrapleural pneumonectomy, has not produced any significant survival advantage. The combination of chemotherapy and a debulking operation followed by radiation therapy in carefully selected patients has been associated with a longer survival time in at least one study in which the selection of patients was probably an important factor. 

Median survival is approximately 20 months no matter how aggressively the patient is treated. The clinician must factor the treatment risks and side effects against this stark reality. Acceptable treatment for patients with this disease ranges from tube thoracostomy with pleurodesis (to treat the symptoms resulting from fluid accumulation) to extrapleural pneumonectomy combined with chemotherapy and radiation, as mentioned above. Pleurectomy followed by radiation therapy has been shown to be as effective as other treatments but it still subjects the patient to a major operation.