Mesothelioma: Treatment, Resources and Clinical Trials
Treatment
Treatment for mesothelioma varies depending on the stage of the disease, the location of the cancer, and the patient's age and overall health. Traditional treatment options include surgery, radiation therapy and chemotherapy. Sometimes more than one treatment is applied.
Surgery
Surgical procedures are palliative, which treat symptoms without aggressively treating the condition itself, curative, which have “curative intent,” and adjuvant therapy, which is aimed at eliminating residual disease. Palliative surgical procedures include:
- Thoracentesis and Pleurodesis - pleural effusion (or build-up of fluid between the lining of a lungs) is relived by draining the fluid. To prevent a re-accumulation of fluid, the pleural space is closed with a sclerosing agent, often a talc slurry.
- Thoracoscopy and Pleurodesis - done together with VATS (see diagnosis) with a powdered form of talk instead of a talc slurry. For this and the previous procedure to be effective, there must be no tumor encasing the lung restricting its expansion.
- Pleuroperitoneal Shunt - a catheter is run under the skin from the pleural to the peritoneal cavity. There are concerns with this procedure because the catheter can become obstructed and the tumor could become seeded into the abdominal cavity.
- Pleurectomy - when more extensive surgery is not advisable, only part of the tumor may be removed to control pleural effusion when the disease limits the lung's expansion.
Potentially curative procedures include:
- Pleurectomy/decortication - this procedure attempts to remove the gross tumor, usually in those with early stage disease (see Mesothelioma: Description and History for a description of the stages). In some cases, pneumonectomy, or removal of the lung, may have to be performed.
- Extrapleural Pneumonectomy - removal of the lung, part of the pericardium, part of the diaphragm, and part of the parietal pleura (membrane lining the chest). Usually done in combination with radiation, chemotherapy, or other new approaches such as immunotherapy, gene therapy, or photodynamic therapy.
- Cytoreductive Surgery - aims at removing the gross or visible tumor in the peritoneal cavity. Remaining cancer cells are treated with Intra-Peritoneal Hyperthermic Chemotherapy (IPHC) in the abdominal cavity.
Chemotherapy
Chemotherapy drugs are used to destroy cancer cells by preventing them from multiplying. Although most are introduced into the body intravenously, the effectiveness of putting drugs directly into the chest or abdomen is being studied. Chemotherapy is sometimes administered through catheters or ports (small reservoir implanted under the skin).
Chemotherapy is not considered “curative.” Its principal goals are to:
- Control the cancer by slowing its growth or stopping its spread
- Shrink tumors prior to other treatments (neoadjuvant chemotherapy)
- Eliminate microscopic diseases that may remain after surgery (adjuvant chemotherapy)
- Relieve symptoms such as pain (palliative chemotherapy)
While chemotherapy is usually an option for mesothelioma patients who are not candidates for surgery, trials are being conducted using the neoadjuvant approach.
For pleural mesothelioma patients who are not candidates for curative surgery, or for whose disease is not resectable, the U.S. Food and Drug Administration (FDA) has approved Alimta (pemetrexed), a new antifolate drug (blocks the activity of folic acid), for use with Cisplatin. Alimta works by blocking enzymes needed for cell division and for copying DNA.
The side effects of Alimta/Cisplatin for most mesothelioma patients tend to be mild or moderate and include nausea, vomiting and fatigue. For other types of chemotherapy, common side effects may include:
- Fever
- Nausea
- Vomiting
- Diarrhea
- Constipation
- Fatigue
- Tingling or numbness in the fingers or toes
- Ringing in the ears
- Bruises or rashes
- Sores in the mouth or throat
Chemotherapy can lower the patient's resistance to drugs and compromise his or her immune system. Other medications most often will also cause adverse interactions. It is important for patients to discuss lifestyle changes and other drugs the patient may be taking with his or her doctor. It may also be advisable for the patient to undergo counseling and to join a support group in order to avoid depression or emotional distress that could also compromise his or her overall health.
Radiation therapy
Radiation therapy, or radiotherapy, uses high-energy beams or streams of radioactive particles to kill cancer cells and shrink tumors or to control symptoms such as pain or shortness of breath. The radiation may be emitted externally from a machine or internally from radioactive materials inserted through thin plastic tubes into the area where the cancer cells are located.
Radiotherapy is sometimes used in combination with surgery. After extrapleural pnuemonectomy, for instance, Intensity Modulated Radiation Therapy (IMRT) may be used to attack residual or microscopic diseases remaining in the chest cavity. Radiation can also help control the spread of the tumor (metastases) along tracks left by invasive procedures such as needle biopsy, thoracoscopy, or chest tube drainage.
A relatively new development in radiotherapy is tomotherapy, an advanced form of IMRT that can accurately target different sized and shaped cancer cell tumors and masses.
Resources and Clinical Trials
For more information and additional resources, please visit the National Cancer Institute's Web site.
The purpose of clinical trials is to study the effectiveness and safety of new drugs. Clinical trials carry potential risks and benefits and a patient should discuss these with his of her doctor prior to becoming a participant. Each trial also has its own eligibility requirements.
For information on clinical trials, please visit the Clinical Trials section on the National Cancer Institute's web site..
If you or a loved one has been diagnosed with mesothelioma, you may be entitled to compensation. An experienced mesothelioma (asbestos litigation) lawyer can advise you of your rights and options.
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