CONVENTIONAL THERAPY FOR MESOTHELIOMA

Conventional mesothelioma therapies include surgery, radiation and chemotherapy. You should keep in mind that if you choose one course of action for mesothelioma treatment, you may preclude other courses. All of your options should be considered as soon as possible.

Surgery

Depending on the stage of a mesothelioma, surgery may be used to remove the cancer and some of the surrounding tissue. Often, however, an operation is not appropriate and the patient may have only minimally invasive procedures to relieve symptoms. A thoracentesis, where fluid in the chest is removed by placing a needle into the chest cavity, may be done to make a patient more comfortable. Sometimes talc or an antibiotic may be injected into the chest cavity to try to prevent the fluid from returning. These techniques are successful in controlling the fluid, at least temporarily, in as many as 90% of patients. Because pleural fluid can compress the lung and cause shortness of breath, these procedures can help patients breathe more easily, however, they do not cure the cancer. In the case of peritoneal mesothelioma, a needle may be inserted into the abdomen to drain the fluid. Similarly, a needle inserted into the pericardium (sac around the heart) can drain pericardial fluid and help relieve circulatory problems. However, draining this fluid may result in complications. Sometimes the cancer cells spread along the needle path, and a tumor nodule may form under the skin of that area.

Surgery for mesothelioma may be performed for one of two reasons: for palliation (to relieve pain and discomfort caused by the tumor), or to cure. Palliative surgery is typically done in cases where the tumor has already spread beyond the mesothelium and is difficult to completely remove, or in cases where the patient is too ill to tolerate a more extensive operation. Curative surgery is offered when the patient is in otherwise good health and the tumor is thought to be localized and can be completely removed. Unfortunately, microscopic spread of cancer cells into the chest wall and diaphragm are common even when such spread cannot be detected by routine tests. Therefore, given the extent of these operations and their very limited success, the exact role of surgery in treating mesothelioma is often debated.

There are two types of operations that may be offered to patients with pleural mesothelioma: pleurectomy/decortication and extrapleural pneumonectomy. Pleurectomy/decortication is usually a palliative (relieves symptoms without curing the cancer) operation in cases where the entire tumor cannot be removed. It involves removal of the pleura, where the majority of the tumor is located. It is effective in controlling effusions (fluid accumulation) and decreasing the pain caused by the cancer.

Extrapleural pneumonectomy is a far more extensive operation and most often used in cases of localized mesothelioma. The operation is technically difficult and performed only by surgeons in large specialized medical centers. It involves removing the pleura, diaphragm, pericardium, and the whole lung on the side of the tumor. The patient must be in overall good health with no other serious illnesses in order to tolerate the large operation. This operation is intended to remove all or most of the cancer and some surrounding tissues as well.

Surgical treatment of peritoneal mesothelioma is often performed either to help relieve symptoms or to attempt to remove the tumor from the wall of the abdomen and other digestive organs. As with pleural mesothelioma, these tumors are often too extensive to remove completely. Similar operations can be performed to remove a mesothelioma from the pericardium (the sac around the heart).


Radiation Therapy for Mesothelioma

Radiation therapy uses high-energy x-rays to kill cancer cells. External beam radiation therapy uses radiation delivered from outside the body that is focused on the cancer. This type of radiation therapy is often used to treat mesothelioma. These treatments are much like getting a diagnostic x-ray except for a longer time. Brachytherapy involves radioactive material being placed directly into the chest or the abdomen at the site of the mesothelioma. Radiation therapy is sometimes used as the main treatment of mesothelioma in some patients, especially those whose general health is too poor to undergo surgery. Adjuvant radiation therapy can be used in addition to surgery to kill small deposits of cancer that cannot be seen and removed during surgery. Palliative radiation therapy can also be used to ease symptoms of mesothelioma such as shortness of breath, pain, bleeding, and difficulty swallowing.

Side effects of radiation therapy may include fatigue and mild skin changes that resemble a sunburn. Often these side effects are temporary. Radiation may also make the side effects of chemotherapy worse. Chest radiation therapy may cause lung damage and lead to difficulty breathing and shortness of breath. Abdominal radiation therapy may cause nausea, vomiting and diarrhea. If you are having any of these side effects of radiation therapy, talk with your doctor since there are ways to help control these symptoms.


Chemotherapy for Mesothelioma

Chemotherapy is the use of drugs for treating cancer. The drugs can be swallowed in pill form or they can be injected by a needle into a vein or muscle. Chemotherapy is systemic therapy. This means that the drug enters the bloodstream and circulates throughout the body (through the whole system) to reach and destroy the cancer cells.

In treating mesothelioma, these drugs may also be given intrapleurally (directly into the chest cavity), or intraperitoneally (into the abdominal cavity). Depending on the type and stage of mesothelioma, chemotherapy may be given as the primary (main) treatment or as an adjuvant (addition) to surgery.

Several anticancer drugs have been used to treat mesothelioma. The drug most effective when given alone is doxorubicin (Adriamycin). Other drugs that may be given alone include cisplatin and methotrexate. These anticancer drugs are often given in combination to try to increase their effectiveness. Combinations of drugs used in the treatment of mesothelioma include methotrexate and vincristine; cisplatin, vinblastine and mitomycin; cisplatin and doxorubicin; and doxorubicin, cyclophosphamide (or ifosfamide) and cisplatin. Other drugs such as paclitaxel and irinotecan are currently being studied to determine their effectiveness in treating mesothelioma.

Chemotherapy drugs kill cancer cells but also damage some normal cells. Therefore, careful attention must be given to avoiding or minimizing side effects, which depend on the specific drugs, the amount taken, and the length of treatment. Temporary side effects might include nausea and vomiting, loss of appetite, loss of hair, and mouth sores. Because chemotherapy can damage the blood-producing cells of the bone marrow, patients may have low blood cell counts. This can result in an increased risk of infection (due to a shortage of white blood cells), bleeding or bruising after minor cuts or injuries (due to a shortage of blood platelets), and fatigue or shortness of breath (due to low red blood cell counts).

Most side effects disappear once treatment is stopped. There are remedies for many of the temporary side effects of chemotherapy. For example, antiemetic drugs can be given to prevent or reduce nausea and vomiting. If you experience any side effects, be sure to talk with your doctor.

EXPERIMENTAL THERAPY FOR MESOTHELIOMA

Several forms of mesothelioma treatment such as the drug Alimta, gene therapy, immunotherapy, photodynamic therapy and multimodality therapy are still in their experimental stages. We invite you to read the following articles on experimental therapies for Malignant Mesothelioma.


Drug Therapy for Mesothelioma

Alimta, a new type of cancer treatment being developed by Eli Lilly, is the first treatment to significantly increase the length of survival and ameliorate the symptoms of the disease. The trial, one of the largest against the fatal disease, was presented at the annual meeting of the American Society of Clinical Oncologists.


Gene Therapy for Mesothelioma

Many strategies of gene therapy are currently under study. Even though the results in animal experiments have been remarkable they have remained disappointing in humans. Other agents such as onconase, thalidomide, lovastatin have been used as single therapy or in combination with chemotherapy with various results.


Immunotherapy for Mesothelioma

This therapy involves the removal of patient cells, activation by exposure to cytokines and reinstillatin into the peritoneum, accompanied by additional chemotherapy. In the few cases tried this form of treatment lead to significant shrinkage of the tumor. However most patients had very early stages of disease, and general recommendations are therefore difficult to make, prior to further research.

Photodynamic Therapy for Mesothelioma

This therapy involves the use of a drug that makes the cancer cells sensitive to a particular wavelength of light. The drug is administered before the surgical procedure. The results have been disappointing, and no survival benefit has been shown in studies so far.


Multimodality Therapy for Mesothelioma

Doctors are always learning more about the best way to treat patients with mesotheliomas. The roles of surgery, radiation therapy, and chemotherapy in the treatment of mesothelioma are highly debated. Treatments which use some combinations of surgery, radiation therapy, and chemotherapy, called multimodality therapy, are now being studied and may provide the most promising option for some patients.