Patients diagnosed with mesothelioma have many treatment options. Mesothelioma treatment can extend life expectancy and improve a patient’s quality of life.
The quality and scope of treatment options for mesothelioma patients is ever increasing. Mesothelioma specialists are refining traditional treatments, such as surgery and chemotherapy. Researchers in clinical trials are producing experimental treatments that can help extend life expectancy. With the help of a qualified specialist, learning more about treatment options can help patients make an informed decisions and improve their prognosis.
Doctors base a patient’s course of treatment on factors such as cancer stage, cancer type, tumor cell type, age and health. A patient’s mesothelioma cell type and stage of cancer play the most important role in determining which treatments are available.
Mesothelioma treatment falls into two categories:
- A curative treatment aims to remove most, if not all, traces of mesothelioma from the body. One of the most common curative surgeries for patients with pleural mesothelioma is the extrapleural pneumonectomy (EPP).
- A palliative treatment aims to increase a patient’s quality of life by managing discomfort and relieving pain caused by mesothelioma symptoms. A common palliative treatment used for patients with pleural mesothelioma is a thoracentesis.
Surgery, chemotherapy, and radiation therapy are the three main types of curative and palliative treatment options for mesothelioma. A multimodal treatment combines two or more of these treatments.
A multimodal treatment is any combination of surgery, radiation therapy and chemotherapy. A study by researchers at a top mesothelioma treatment facility, the Dana Farber Cancer Center, showed that 22 percent of the patients who had multimodal treatment lived at least 5 years.
Specialists using multimodal treatment can target mesothelioma tumors with radiation therapy or chemotherapy before surgery (neoadjuvant) and after surgery (adjuvant).
The Multimodal Process
The patient receives treatment—usually chemotherapy—to help shrink the tumor and increase the success of surgery.
Specialists use surgery to remove as much of the tumor as possible. Chemotherapy is an option for those who don’t qualify for surgery.
The goal of adjuvant treatment is to manage any tumor recurrence or symptoms. Adjuvant treatment is often radiation therapy or chemotherapy.
One of the most successful multimodal treatments for patients with peritoneal mesothelioma is cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC).
The aim of this chemotherapeutic procedure is to wipe out postoperative remnants of mesothelioma cells in the peritoneum. HIPEC bathes the abdomen in a heated chemotherapeutic drug for 60 to 90 minutes. The drug cocktail (made of mitomycin or a combination of cisplatin and doxorubicin) is then drained.
Several studies have shown the success patients have had with cytoreductive with HIPEC. One recent study reported that the median overall survival rate for patients who underwent this procedure was just over 5 years.
Pleural Mesothelioma Surgery
A P/D is considered the first treatment option for patients diagnosed with stage one mesothelioma. It works best if the cancer has not yet spread to nearby lymph nodes.
The procedure involves the removal of the pleura (pleurectomy) and the surface layer of the lung (decortication).
Extended P/D is a more radical version of this procedure. It involves the removal of the diaphragm and pericardium in addition to the pleura.
This surgery is not considered curative, as traces of the tumor can remain after the procedure. The main goal of a P/D is to relieve breathing issues resulting from the buildup of excess fluid in the pleural cavity. Decortication also helps reduce breathing difficulties caused by the hardening of the pleura.
90 percent of patients who have a P/D experience a reduction of symptoms caused by pleural mesothelioma. The median survival rate for patients after a P/D is 20 months.
An EPP is most aggressive surgery available for patients diagnosed with pleural mesothelioma. During this procedure, a surgeon removes the entire diseased lung and pleura (lining of the lungs). The diaphragm, nearby lymph nodes, and pericardium (lining of the heart) may also be removed to prevent the spread or recurrence of mesothelioma.
A study on the effectiveness of an EPP demonstrated that patients treated with this procedure survived up to 3 years after surgery.
Peritoneal Mesothelioma Surgery
This surgery involves the removal of all parts of the peritoneum (lining of the abdomen) affected by tumor growth. It also targets any visible tumors that may have spread to nearby organs. Doctors often combine several peritonectomy surgeries with hyperthermic intraperitoneal chemotherapy (HIPEC). This combined procedure is known as a cytoreduction with HIPEC and is recognized as the standard treatment for peritoneal mesothelioma.
A cytoreductive surgery aims for the removal of as much tumor matter as possible. Cytoreductive surgery can be successful for early-stage patients with good health and a responsive tumor cell type. Patients interested in electing an aggressive cytoreductive surgery should consult a mesothelioma specialist. Aggressive cytoreductive surgery presents an increased risk of postoperative complications and death.
Chemotherapy is the use of drugs that attack cancer while it resides in the body. The effectiveness of chemotherapy depends on the cancer’s stage and location. It can be used before (neoadjuvant), during therapy (intraoperative), or after therapy (adjuvant).
There are two methods doctors use to apply a chemotherapeutic treatment.
Doctors introduce the chemotherapy into the bloodstream using pills or an IV. The chemotherapy runs through the patient’s bloodstream and attacks any cancer cell it contacts.
Surgeons introduce the chemotherapy into the pleural or peritoneal cavity using a small tube.
Chemotherapeutic drugs are often combined to improve effectiveness. One of the most common combinations are pemetrexed (also known as Alimta) and cisplatin.
The side effects that result from chemotherapy may be serious, but do not tend to last long after the drugs are taken. Many factors play a role in the severity of a side effect. These factors include the type of drug, the amount of the dose, and the length of time the drug is administered.
Common side effects experience during chemotherapy are:
- Hair loss
- Loss of appetite
Physicians can use radiation therapy by itself (as a palliative treatment) or combine it with curative surgery. Its high energy rays can be targeted with great accuracy, so its side effects are not as severe those associated with chemotherapy. Research has shown that radiation therapy used after surgery (adjuvant) on patients with pleural mesothelioma worked well to prevent tumors from returning and increased overall survival.
The most common radiation therapy used for mesothelioma patients are:
Three-Dimensional Radiation Treatment (3D-CRT)
Doctors customize a radiation dose for a tumor by using 3D scans. This provides more accurate targeting and minimizes the effect the therapy has on nearby organs.
Intensity-Modulated Radiation Therapy (IMRT)
IMRT is an advanced form of the 3D-CRT. This procedure applies a self-adjusting beam of radiation around the patient’s body. The beam adjusts its intensity when it passes over the tumor so that surrounding tissues are not damaged. One study showed that IMRT used after an extrapleural pneumonectomy (EPP) yielded a median overall survival rate of just over 2 years. 41 percent of the patients survived 3 years after the combined procedure.
Radiation Therapy Side-Effects
The side-effects associated with radiation therapy are less severe than those associated with chemotherapy. The high doses of radiation necessary to kill cancer cells may damage healthy cells in the area surrounding the targeted tumor.
- Inflammation of the esophagus
- Skin redness
- Hair loss
The course of treatment shifts focus once a patient reaches stage III or IV. Doctors use palliative treatment to ease discomfort caused by advanced-stage symptoms. The type of palliative treatment depends on the location of the cancer and its stage.
Pleural effusions can affect a patient’s ability to breath, diminishing his or her quality of life. Palliative treatments designed to ease symptoms associated with pleural mesothelioma include:
The surgeon inserts a needle into the pleural cavity and drains excess pleural fluid. A thoracentesis reduces the pressure caused by the buildup of fluid in the pleural cavity (the space between the inner and outer lining of the lungs).
Video assisted thoracoscopic talc pleurodesis (VATS)
Assisted by a camera, the surgeon drains excess fluid from the pleural cavity and blows talc into the drained space. The talc causes an inflammatory reaction that closes the pleural space. Scar tissue formed over time can prevent fluid buildup from reoccurring. VATS talc pleurodesis helps stop the chest pain and pressure caused by fluid buildup.
A surgeon removes part of the hardened pleura so that the lung can re-expand. A partial pleurectomy helps patients with pleural mesothelioma breath easier.
A needle is inserted into the peritoneal cavity and excess fluid is drained. A paracentesis helps ease the pressure caused by ascites, the buildup of fluid in the abdominal cavity. Ascites can cause abdominal pain for patients with peritoneal mesothelioma.
Participation in clinical trials can increase the chance of an improved prognosis. Researchers are developing promising treatments that target the genetic makeup of mesothelioma.
One such treatment is a combination of chemotherapy (Pemetrexed and Cisplatin) and a vaccine called CRS 207. CRS 207 helps the immune system attack mesothelin, a protein that is overexpressed in mesothelioma. The combination of chemotherapy and CRS 207 kills cancer cells and helps strengthen the patient’s body to fight cancer.