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Treatment information for mesothelioma patients

There are several different treatment options for mesothelioma and your doctor will make recommendations based on a number of different factors:   the size of the cancer, its location, whether or not it has spread, what the cells look like, your age and general overall health.  

Surgery

Surgery is the most common treatment option for mesothelioma. There are two main types of surgical treatment for pleural mesothelioma: extrapleural pneumonectomy and pleurectomy.

Pleurectomy involves the removal of the pleura, the thin sac surrounding the lung. Since complete surgical removal of the entire tumor is unlikely, this procedure is generally performed to reduce pain caused by the tumor mass or to prevent the recurrence of pleural effusion.

In select medical centers, thoracic surgeons with special training and facilities perform a major radical surgery called extrapleural pneumonectomy.  The entire pleura and the lung on the affected side are removed.  Frequently, the diaphragm and pericardium (the lining around the heart) on the affected side are also removed. Synthetic materials are then used to reconstruct the diaphragm, primarily to keep the content of the chest separate from the abdomen.

Extrapleural pneumonectomy is a very intensive procedure, and it can take up to a year for patients to recover, if they survive that long.  There are serious issues that must be considered before going forward with this surgery, even when it may be an option.   This aggressive treatment is only available in major medical centers and teaching hospitals by surgeons who carefully select patients based on age, overall health and the stage of their mesothelioma.  The surgery and follow up is extremely costly, upwards of $150,000.   Some patients decline this treatment because of the high cost, pain and discomfort of such rigorous surgery and follow up treatments.

Radiation therapy

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors in specific locations within the body.  It is sometimes used as the main treatment, especially in patients who may not be strong enough to manage chemotherapy or radical surgery.  Radiation therapy is ‘delivered’ from a machine outside of the body, known as external radiation therapy, or from safe radioactive materials that are placed directly into the chest or the abdomen at the site of the Mesothelioma, known as Brachytherapy.

Radiation therapy is sometimes used in conjunction with chemotherapy. The use of radiation therapy in pleural mesothelioma has been shown to alleviate pain and suffering related to Mesothelioma and helps improve problems such as shortness of breath in the majority of patients treated.

Chemotherapy

Chemotherapy uses anticancer drugs to kill cancer cells throughout the body.  It can be used to shrink a tumor before surgery takes place, to destroy cancer cells that remain after surgery, or to make radiation therapy work more effectively.  In some instances chemotherapy is used as the only treatment, when surgery is not appropriate for the patient.

These powerful medications may be taken as pills or they may be put into the body by a needle in the vein or muscle. Chemotherapy drugs may be given as single agents, but more often, two or more drugs are given at the same time, known as combination therapy.  Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body. In mesothelioma, chemotherapy may be put directly into the chest (intrapleural chemotherapy). Once chemotherapy is completed, normal cells usually recover and most side effects gradually disappear after treatment ends.

Various cancer centers are conducting trials of Alimta (pemetrexed), a new drug recently approved by the Food and Drug Administration for use with Cisplatin in the treatment of patients with malignant pleural mesothelioma who are not candidates for curative surgery. Alimta is the first drug approval specific to mesothelioma. In the simplest description, Alimta works by blocking the enzymes necessary for DNA copying and cell division. During the clinical trial process, Alimta/Cisplatin improved median survival for pleural mesothelioma patients by approximately three months over treatment with Cisplatin as a single agent.  

New Treatments

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