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Multi-segment filter elements typically are provided from so-called six-up filter rods, four-up filter rods and two-up filter rods that are of the general format and configuration conventionally used for the manufacture of filtered cigarettes can be handled using conventional-type or suitably modified cigarette rod handling devices, such as tipping devices available as Lab MAX, MAX, MAX S or MAX 80 from Hauni-Werke Korber & Co

Luo, Xuan et al

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EEP constitutes a more radical approach, but in recent years its advantages over pleurectomy/decortication have been questioned.62,63 No superiority was observed for either technique in a recent randomized study performed in the United Kingdom (the Mesothelioma and Radical Surgery [MARS] study).64 Nevertheless, the MARS study has been severely criticized, due to significant deviations from the original protocol design and the number of patients finally included in one of the study groups.65 In any case, although some groups with extensive experience in both techniques find it unacceptable to forgo resection of grossly visible tumor (giving a poorer prognosis),54 the idea of resecting the greatest tumor volume possible, while preserving the underlying lung and combining surgery with chemotherapy and radiation therapy in multimodal treatment, is gaining ground.66 Radiation Therapy in Malignant Mesothelioma Radical radiation therapy administered to the whole hemithorax is seriously limited by the risk of damaging critical organs, such as the lung, liver, heart, bone marrow and esophagus, although these negative effects are being palliated by optimized application techniques.67 However, there is no convincing evidence that this alone prolongs survival in mesothelioma.68 On the other hand, palliative radiation therapy plays an important role in the control of pain from chest wall infiltration.69,70 The classic recommendation has been to administer prophylactic radiation therapy to avoid tumor seeding in the thoracoscopy or thoracotomy scars,71,72 but this practice is not supported by available evidence, and is no longer advised.27,28 Chemotherapy, Immunotherapy and Other Tailored Treatments Recent clinical guidelines advise against delaying the administration of chemotherapy, which must be considered before the patient's functional status begins to deteriorate.27,28 The combination of various agents, including pemetrexed and platinum compounds, generally produces better results than monotherapy.73,74 Current trends in research are oriented toward new therapeutic targets focused on controlling angiogenesis and apoptotic pathways via specific ligands, such as platelet derived growth factor (PDGF, that is quite often expressed in the mesothelioma and associated with poorer survival) and mesothelin (expressed only in the epithelioid subtype), among others.75,76 Immunotherapy is another aspect of multimodal therapy that can be effective in the treatment of mesothelioma, since this tumor uses regulatory T-cells (Tregs) and M2 macrophages to escape the immune system

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