Treatment Options
While a variety of treatments are currently available. Only a doctor or, preferably a mesothelioma specialist will be able to determine appropriate treatment action for an individual patient. Treatment programs are designed based on factors such as: A patient’s age, health condition, date of diagnosis, type of mesothelioma (pleural mesothelioma, peritoneal mesothelioma or pericardial mesothelioma) and stage to which the cancer has spread. Treatments may include, radiation therapy, chemotherapy, surgery, clinical trials, drug therapy or a combination thereof (called multimodal treatment).
Radiation Therapy
Radiation therapy uses high energy x-rays to damage or kill cancer cells. Though it is not a cure for mesothelioma, radiation therapy may be used to delay the cancers growth. When used in combination with surgery, radiation therapy is referred to as adjuvant radiation and can be used to destroy small deposits of cancer that may have been missed in surgery.
External Beam Radiation
External beam radiation uses radiation delivered from outside the body. During treatment, a machine similar to an x-ray machine directs intense beams of light from outside the body at the cancer. It is the most commonly used form of radiation used in the treatment of mesothelioma.
Brachytherapy
Brachytherapy involves placing sources of radiation inside the body. Radioactive sources are positioned in the patient’s abdomen or chest, either close to, or inside the tumor itself.
Chemotherapy
Chemotherapy uses drugs or chemical agents to treat cancer. A doctor or mesothelioma specialist may recommend a single drug, or a combination of drugs. Chemotherapy drugs are systemic, meaning that the drugs are designed to enter the bloodstream and then circulate throughout the patient’s body or ’system’ to destroy the cancer cells. The drugs may be injected by needle into a vein or muscle or swallowed in pill form. In treating mesothelioma specifically, these drugs may also be given directly into the chest cavity (intrapleurally), or into the abdominal cavity (intraperitoneally). While not a cure for mesothelioma, chemotherapy may help delay the progression of the cancer.
Surgery
Surgery may be used in one of two ways: as a palliative treatment (to relieve pain and discomfort caused by the disease) or, as a curative treatment (to cure or slow the progression of mesothelioma). Surgery may be performed in conjunction with other radiation or chemotherapy treatments, this is known as “multi-modal therapy.” Whether surgery is indicated depends on many factors, including the patient’s medical history, the health of the patient and the location and stage (extent to which the cancer has spread) and cell type of the cancer.
Surgery Options for Pleural Mesothelioma
Pleurodesis
Pleurodesis is a surgical procedure to help control pleural effusion, which is the buildup of fluid between the lungs and the lung lining. The goal with pleurodesis is to close the space between the lung and the lung lining, reducing the potential for fluid accumulation. There are two approaches to performing pleurodesis. In the first, a tube that is inserted into the chest in order to drain excess fluid. After this fluid is drained, a schlerosing agent (a substance that causes tissue to scar or harden), such as talc (see below), is injected through the chest tube and into the pleural space. The second method, called thoracentesis uses thoracoscopy, whereby a small incision is made in the chest and a thoracoscope, which is an instrument similar to a telescope and is connected to a video camera, is passed through the incision and inserted in the area of the tumor to get a better look at the pleura. The sclerosing agent is then applied
The Role of Talc
Pleurodesis is the most commonly used method for preventing pleural effusion in the future after the fluid has been drained. The typical form of pleurodesis is by blowing talc or a talc slurry into the lungs while the doctor is using an endoscope to view the inside of the lungs. After the slurry is inside, the patient needs to rotate into six different positions over the next hour and a half to make sure the slurry covers all parts of the inside of the lung. The talc then helps macrophages accumulate which in turn assists in coagulation and prevention of future pleural fluid accumulation.
Pleurectomy/Decortication
Pleurectomy/decortication involves removing the affected pleura where the tumor is located, thus freeing the underlying lung and allowing it to fill the pleural cavity. The literal meaning of this term is the stripping away of a rind. This procedure is typically referred to as a “palliative treatment”, meaning that its goal is to help to ease the discomfort caused by the pleural effusion caused by mesothelioma.
Pneumonectomy
Is the removal of all or part of the lung and surrounding tissues.
Extrapleural pneumonectomy (EPP)
EPP is a procedure that may involve the removal of the lung, pleura or pericardium and/or surrounding tissue. This operation is intended to remove all or most of the cancer and some surrounding tissue as well that may have been affected. It is an extensive procedure that requires the patient to be in good health.
Surgery Options for Peritoneal Mesothelioma
Paracentesis
Peritoneal mesothelioma can cause fluid to build up in the abdomen in a process called peritoneal effusion. This excess fluid is drained through a needle and tube inserted into the abdomen. Sometimes referred to as an “ascitic tap”, paracentesis helps relieve pressure from the other internal organs and reduces the risk of infection caused by the fluid buildup.
Peritonectomy
Peritonectomy is a surgery that involves the removal of the affected peritoneum (abdominal lining), housing the mesothelioma. This form of surgery is commonly utilized in cases where the cancer is detected early.
Laparotomy
In this procedure, a surgeon opens the abdominal cavity and removes as much of tumor as possible.
Surgery Options for Pericardial Mesothelioma
If pericardial tumors have not metasticized (spread) to the lungs, abdomen or lymph nodes, surgery may be used to successfully remove most or all of the cancerous tissue.
Pericardiocentesis
In this procedure, a needle is inserted into the pericardium (the membrane lining the heart) in order to drain the fluid out of the affected area. This helps to relieve circulatory problems and the discomfort associated with pericardial mesothelioma.
Clinical Trials
In a clinical trial, human volunteers are used to test experimental therapies and their effectiveness. These studies are conducted under controlled environments and usually have limited participation. If you are interested in participating in a clinical trial, talk to your doctor or mesothelioma specialist about whether a clinical trial may be an option. Clinical trials are broken down into three phases.
Phase I
Phase I trials are the first step in testing the effectiveness and safety of a new drug. Doctors and researchers try to determine the best way to give a new treatment and the correct dosage for the treatment in order to determine a drug’s safety and potential side effects.
Phase II
The purpose of a phase II trial is to determine if the drug works.
At this stage, researchers select a relatively small group of patients to study the specific effects of the dosage (set by evaluating the reslults of phase I).
Phase III
In Phase III testing, doctors and researchers compare the effectiveness of the new, experimental drug against existing standard (most accepted) therapies. The trials often involve large numbers of patients. Often, patients enrolled in the clinical trial will be randomly assigned to therapeutic group (either a “control” group or an experimental group) in an attempt to eliminate the possibility of human bias. Participants are closely monitored for signs of improvement or side effects. The testing may be terminated if side effects of the new treatment are too severe or if one therapeutic group quickly experiences much better results than others.
New & ExperimentalTharapiess
Cancer specialists and researchers are always looking for new and better ways to effectively treat mesothelioma. Several treatments show promise in helping to treat and lessen the symptoms of mesothelioma.
Photodynamic Therapy
Photodynamic therapy or PDT uses laser light to kill cancer cells. The Food and Drug Administration (FDA) has approved its use for non-small cell lung cancer and cancer of the esophagus. However, photodynamic therapy is in the experimental stage as treatment for mesothelioma.
Immunotherapy
The immune system plays a central role in both protecting the body against disease caused by certain viruses and bacteria, and combating disease that has already developed. Immunotherapy treatment is based of boosting the body’s own immune system’s reaction to fight mesothelioma. Experimental treatments include the use of interferons or interleukins, that have hormone-like properties that activate the immune system.
Gene Therapy
Gene therapy is a technique for correcting or replacing defective or weakened genes responsible for the development of disease. While still in its infancy for the treatment of mesothelioma, gene therapy holds a lot of promise for future cancer patients.
Source: Connelly & Vogelzang
