Mesothelioma Treatment, Medical Malignant Peritoneal Mesothelioma Pleural Surgery, Doctors Clinics and Treatment Options, Pleurectomy Radiation Chemotherapy

Before any surgery is considered for the treatment of malignant mesothelioma, the patient's overall health is carefully evaluated. Tests are performed to make sure the patient has no metastatic disease (cancer spread to distant sites) and to evaluate the patient's pulmonary (lung) and cardiac (heart) function. Pulmonary function is often compromised in patients with pleural mesothelioma for several reasons. The pleural effusion (fluid collection) and the tumor mass caused by mesothelioma can compress the lung. Also, the patient's exposure to asbestos may have decreased lung function, which also decreases with age. In addition, some patients have a history of smoking cigarettes, which further decreases lung function.Surgery for malignant mesothelioma may be aimed at cure (aggressive surgery) or relief of symptoms (palliative procedures). Aggressive surgery - Extrapleural pneumonectomy involves removal of the pleura, the lung, the diaphragm and the pericardium. The intent of this very aggressive, complicated surgery is to remove as much of the tumor as possible. Not all centers will perform this procedure because of its complexity and because it carries a high risk of postoperative mortality (death within 30 days after surgery). Extrapleural pneumonectomy is typically performed only in younger patients in good overall health with stage I disease. Patients are evaluated carefully to determine their ability to tolerate the surgery. Palliative procedures - When malignant mesothelioma is advanced, palliative procedures may be performed to relieve and/or control symptoms such as breathlessness and pain, which are caused by effusion (fluid collection) or by the tumor compressing the lung or other organs. These procedures do not aim to cure the disease.

Because of the location of malignant mesothelioma, it is extremely difficult to deliver high enough doses of radiation to kill the tumor without damaging the surrounding organs. Lower doses of radiation may result in some reduction in the disease, but it is unclear whether this reduction actually results in longer survival than does no treatment. Using radiation therapy after surgery has not been shown to improve survival. However, because surgery is very unlikely to remove the entire tumor, radiation is commonly administered after surgery in the hopes of killing remaining tumor cells. In addition, radiation therapy can be used to relieve symptoms of mesothelioma, including pain and shortness of breath.

Chemotherapy - the use of medications to treat cancer - has had disappointing results in the treatment of malignant mesothelioma. Some chemotherapy drugs have a partial effect in some patients. Combination chemotherapy (using more than one drug at the same time) may be given in an attempt to improve response. Some combinations have shown some promise, and some new medications are being tried. Like radiation therapy, chemotherapy may be administered after surgery in an attempt to kill cancer cells that could not be removed during the procedure. Mesothelioma - Treatment By Stage Pleural mesothelioma can be treated according to stage; there are no standard treatment options by stage for peritoneal mesothelioma. Stage I (localized) mesothelioma - If a patient wants aggressive treatment and is deemed fit to undergo surgery, some centers may perform an extrapleural pneumonectomy. Another surgical option is pleurectomy/decortication, which is sometimes performed to alleviate some of the symptoms of mesothelioma. Both of these procedures may be followed by radiation therapy or chemotherapy. Alternatively, radiation therapy may be used alone, without surgery, for the relief of symptoms. Stages II, III and IV (advanced) mesothelioma - Pleurectomy/decortication may be performed to relieve symptoms in pleural mesothelioma. Other procedures such as thoracentesis may be performed to drain pleural effusions and prevent them from recurring. Radiation therapy and/or chemotherapy may also be administered for symptom relief. Recurrent malignant mesothelioma - There is no standard treatment for recurrent mesothelioma; generally, treatments are chosen that were not used in the first treatment attempt.

Mesothelioma - Clinical Trials & Future Treatments New treatments for malignant mesothelioma (and possible preventive measures, such as a vaccine) are being evaluated in clinical trials, and the future holds some promise. Clinical trials are research studies that evaluate new treatments for safety and effectiveness. There are no guarantees that a new treatment will work, and there are some risks; however, a clinical trial is not undertaken unless the researchers believe the treatment may have some value. Here are some of the treatments for malignant mesothelioma that are being evaluated:

Combination chemotherapy - Different combinations of chemotherapy drugs have been tried with mixed results. A recent study showed some benefit of combining cisplatin and gemcitabine. The researchers used the combination to treat 21 patients with advanced mesothelioma, of whom 47 percent showed a partial response.
Other medications - One study showed that lovastatin, a cholesterol-lowering drug, may be useful for the treatment of malignant mesothelioma. The drug was found to induce apoptosis (cell death) in mesothelioma cells, which may increase the effectiveness of radiation therapy and chemotherapy.
Intracavitary chemotherapy - Instilling chemotherapy drugs directly into the pleural or peritoneal space is being researched because of its advantage over traditional chemotherapy: because the drug is instilled directly into the cavity, much greater doses can be given to patients without causing severe side effects. Some studies have shown this therapy to result in control of effusions and reduced tumor size.
Brachytherapy (intracavitary radiation therapy) - In this treatment, a radioactive substance is placed directly into the pleural or peritoneal space.
Multimodality therapy - Any combination of surgery, radiation therapy and chemotherapy is multimodality therapy. For example, researchers have combined surgery with intracavitary radiation or chemotherapy and then administered radiation or chemotherapy afterward. Some physicians are administering chemotherapy before surgery in an attempt to decrease the size of the tumor.
Gene therapy - In this approach, a virus that has been genetically altered is introduced into the tumor. The virus infects the tumor cells and makes them vulnerable to anticancer drugs.
Immunotherapy - Treatments that stimulate the body's immune system to fight cancer cells are called immunotherapy.
Photodynamic therapy - In this treatment, drugs that are sensitive to light are taken up by the tumor cells, which are then exposed to light.