Mesothelioma Treatment Options

While there is currently no cure available for malignant mesothelioma, there are treatments available. The types of treatments may include:

• Surgery
• Radiation
• Chemotherapy
• Intraoperative photodynamic therapy
• Immunotherapy
• Gene therapy

Surgery

Surgery is commonly used in the treatment of malignant mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed. Depending on how far the cancer has spread, a lung also may be removed (pneumonectomy). The following are some of the most commonly used surgical treatments of mesothelioma:

Pleurodesis

Pleurodesis is a treatment administered through a thoracoscopy or existing chest tube. Pleurodesis creates inflammation effectively eliminating the pleural space. The elimination of this space then inhibits the accumulation of a pleural effusion. Generally used when the pleural effusion is symptomatic. Talc is used most commonly and effectively for this procedure, thus it is often referred to as "talcing" or as a patient having been "talced."

Pleurectomy

Surgery to remove part of the chest or abdomen lining (pleura) and some of the tissue surrounding it. This procedure is performed for a variety of disorders including pleural effusion, malignant pleural mesothelioma, and trauma.

Pleurectomy/decortication

Surgery to remove part of the chest or abdomen lining (pleura) and as much for the tumor mass as possible. This procedure may be performed to reduce pain caused by the tumor mass or to prevent the recurrence of pleural effusion. For peritoneal mesothelioma, surgery is generally aimed at relieving symptoms, such as recurrent ascites or bowel obstruction. As with pleural mesothelioma, complete surgical removal of the entire tumor is unlikely.

Pneumonectomy (new-mo-NEK-to-me)

Surgery to remove a lung.

Extra pleural pneumonectomy (or EPP)

Surgery to remove the pleura, diaphragm, pericardium, and entire lung involved with the tumor. You can view a web cast from Brigham and Women's Hospital in Boston of this procedure being done by Dr. David Sugarbaker: see the extrapleural pneumonectomy (EPP) web cast here.

Radiation therapy

High-energy x-rays, gamma rays, neutrons, and other sources of radiation are used to kill cancer cells and shrink tumors. Radiation coming from a machine outside the body is referred to as external radiation therapy or external-beam radiation therapy. Radiation may also come from materials that produce radiation called radioisotopes. Radioisotopes can be inserted in or near the cancerous cells or tumors; this type of radiation therapy is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy, also referred to as radiotherapy, irradiation, and x-ray therapy, uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body.

Chemotherapy

Using drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. 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).

Intraoperative photodynamic therapy

A new type of treatment that uses special drugs and light to kill cancer cells during surgery. A drug that makes cancer cells more sensitive to light is injected into a vein several days before surgery. During surgery to remove as much of the cancer as possible, a special light is used to shine on the pleura. This treatment is being studied for early stages of mesothelioma in the chest.

Immunotherapy

This new approach uses the body's own immune system to fight the cancer within the body. Immunotherapy treatments are currently being evaluated in clinical trials.

Gene therapy

This approach is designed to treat mesothelioma by correcting the genes that allow a cancerous tumor to grow, potentially controlling tumor size and spread. Like immunotherapy, gene therapy clinical trials are currently underway. [Mesothelioma Gene Therapy >>]

Regarding these treatments

It should be noted that recent studies indicate using a single one of the above listed treatments for malignant mesothelioma has failed to improve patient survival rates; instead, patient survival is being increased when treatment includes a combination of approaches —for instance surgery followed by chemotherapy and radiotherapy. This is called the "multimodality approach," meaning an approach using many modes of treatment.