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 as mesothelioma specialists refine traditional treatments, such as surgery and chemotherapy.Additionally, researchers in clinical trials are producing experimental treatments that can help extend life expectancy.
With the help of an experienced mesothelioma specialist, learning more about treatment options can help patients make informed decisions about getting care and improving their prognosis.
Doctors base a patient’s course of treatment on factors such as cancer stage, cancer location, tumor cell type, age and health.
Out of these factors, a patient’s mesothelioma cell type and cancer stage 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. The most successful curative surgeries for patients with pleural mesothelioma are the extrapleural pneumonectomy (EPP) and the pleurectomy with decortication (P/D).
- A palliative treatment aims to increase a patient’s quality of life by managing the discomfort and pain caused by mesothelioma symptoms. The most common palliative treatment used for patients with pleural mesothelioma is a thoracentesis, while peritoneal mesothelioma patients most often receive a paracentesis.
Surgery, chemotherapy, and radiation therapy are the three main types of curative and palliative treatment options for mesothelioma. Multimodal therapy combines two or more of these treatments into one combined course of treatment.
A multimodal therapy is any combination of one or more of the following: surgery, radiation therapy and chemotherapy.
Combining multiple treatments has proven incredibly successful in extending the average life expectancy and survival times of patients across the board. A study by researchers at Dana Farber Cancer Center, a top mesothelioma treatment facility, showed that 22 percent of the patients who had multimodal therapy lived at least 5 years.
Specialists using multimodal treatment can target mesothelioma tumors with radiation therapy or chemotherapy before surgery (neoadjuvant), during surgery (intraoperative) 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).
This procedure combines cytoreductive surgery, which removes visible tumors from a patient’s abdomen, with heated intraperitoneal chemotherapy (HIPEC).
Several studies have shown the success produced by specialists using cytoreduction with HIPEC. One recent study reported that the procedure produced a median overall survival rate of just over 5 years, a considerable improvement over the 12 – 14 month average survival rate currently experienced by patients with peritoneal mesothelioma.
Cytoreduction with HIPEC was innovated and developed by Dr. Paul Sugarbaker, world-renowned mesothelioma specialist. If you’re a patient diagnosed with mesothelioma, our Patient Help Team can help connect you with Dr. Paul Sugarbaker or another experienced specialist.
Pleural Mesothelioma Surgery
Pleurectomy with Decortication (P/D)
A Pleurectomy with Decortication is considered the first treatment option for patients diagnosed with stage one mesothelioma and produces the best results 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).
An extended P/D is the more radical version of this procedure. It involves the removal of the diaphragm and pericardium in addition to the pleura.
The P/D is not technically considered curative, as traces of the tumor can remain after the procedure. Its main goal is to relieve symptoms, such as breathing issues, caused by the buildup of excess fluid in the pleural cavity and the hardening of the lung’s lining.
90 percent of patients who have a P/D experience a reduction of symptoms, and the median survival rate for patients after the procedure is 20 months.
Extrapleural Pneumonectomy (EPP)
An Extrapleural Pneumonectomy 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 the 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. It can produce incredible results for patients in good health who are diagnosed with early-stage mesothelioma. Patients interested in electing an aggressive cytoreductive surgery should consult a mesothelioma specialist, because aggressive cytoreductive surgery can possibly increase the risk of postoperative complications.
Chemotherapy is the use of drugs that attack and kill cancer. The effectiveness of chemotherapy on mesothelioma depends on the cancer stage and location of the disease. It can also be used before surgery (neoadjuvant), during surgery (intraoperative), or after surgery (adjuvant).
There are two methods doctors use to apply chemotherapy:
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 directly into the pleural or peritoneal cavity during surgery. The chemotherapy drugs are usually heated to boost their cancer-killing effectiveness.
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 was administered.
Common side effects experience during chemotherapy are:
- Hair loss
- Loss of appetite
For mesothelioma treatment, specialists use radiation therapy by itself (as a palliative treatment) or combine it with curative surgery. Its high energy rays can be targeted with some measure of accuracy, so its side effects are not as severe those associated with chemotherapy.
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. The radiation beam produced by IMRT 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. Additionally, 41 percent of the patients survived 3 years after the 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, however, may damage healthy cells in the area surrounding the targeted tumor.
Common side effects cause by radiation therapy include:
- Inflammation of the esophagus
- Skin redness
- Hair loss
The course of treatment shifts focus once a patient reaches stage three or 4. Instead of curative treatment designed to remove cancer from the body, doctors begin to use palliative treatment, the goal of which is to ease discomfort or pain caused by advanced-stage symptoms.
The type of palliative treatment depends on the location of the mesothelioma and its stage.
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 constantly developing treatments that target the genetic makeup of mesothelioma and even help the body’s own immune system fight the disease.
One such treatment is a combination of chemotherapy (Alimta and Cisplatin) and a vaccine called CRS 207. CRS 207 helps the immune system attack mesothelin, a protein that is abundant in mesothelioma. The combination of chemotherapy and CRS 207 has demonstrated its effectiveness in killing cancer cells and will continue to be developed into a full-fledged treatment.
Participating in clinical trials can be beneficial for patients with any stage of mesothelioma. If you’ve been diagnosed with mesothelioma, we can help you decide if taking part in a clinical trial is right for you, and can even help connect you to one.