Treating mesothelioma is as challenging as diagnosing it. The key to effective treatment is the early identification of the mesothelioma. The earlier the diagnosis, the wider the treatment options. While there are now experimental treatments for mesothelioma, the three cardinal approaches to mesothelioma treatment remain: surgery, radiation therapy, and chemotherapy. For certain individuals, a combination of the three can provide better prognosis and better quality of life.
Among patients with Stage I and Stage II mesothelioma, their best treatment option is surgery. This is because the borders of the mesothelioma tumor are still well-defined and the cancer cells themselves have not yet begun migrating to other parts of the body via the lymphatics. Surgery as mesothelioma treatment can take on two major forms: potentially curative and palliative.
Potentially curative surgical procedures are designed primarily to remove the primary tumor with the goal of improving prognosis and extending the life expectancy of the patient. It is called “potentially curative” because there are no guarantees that it will completely eradicate the cancer problem. Nevertheless, it provides one of the best chances of survival among patients with mesothelioma.
There are 2 surgical procedures that mesothelioma specialists use today to manage pleural mesotheliomas.
For peritoneal mesothelioma, the preferred surgical procedure is the Cytoreductive surgery which is almost similar in approach to Pleurectomy Decortication. The only difference is that it is the peritoneum that is removed including any visible tumors. Some thoracic surgeons are now using robotic surgery for more pinpoint accuracy in the removal of tumors.
The second type of surgical procedure of therapeutic nature is palliative surgery. The goal of this surgery is not to improve prognosis or lengthen life expectancy. Instead it is the improvement in the quality of life through a reduction of the associated symptoms particularly pain. Examples of these palliative surgeries include pleurodesis, paracentesis, thoracotomy, wedge resection, lobectomy, pneumonectomy, and shunt placement.
One of the mesothelioma treatments that can be used in all stages of the cancer is radiation therapy, although its usefulness in later cancer stages remain debatable. Nevertheless, radiation therapy, or radiotherapy, involves the use of targeted radiation to kill cancer cells as well as reduce the size of the tumor. If done correctly and early, it can provide excellent results with fewer side effects than oncology agents.
Radiation therapy is primarily indicated in the palliative management of cancer pain as well as in the prevention of seeding which can occur in 20-50% of mesothelioma patients undergoing any type or surgical procedure. For individuals who are not suited for surgical procedures, a combination of chemotherapy and radiotherapy can help improve life expectancy at the same time provide palliative treatment and improve the quality of life.
For pleural mesothelioma patients, there are currently 2 radiation therapy protocols that can provide relief. These include external beam radiation and intraoperative radiation. External beam radiation requires the precise targeting of cancer cells so that normal healthy cells are not damaged or destroyed in the process. Intraoperative radiation is a type of radiation therapy that is used in conjunction with surgical procedures, particularly Extrapulmonary Pneumonectomy. During the surgical procedures, high intensity radiation is applied onto the affected areas in order to kill stray cancer cells and prevent seeding of cancer cells. Some oncologists now use radiation therapy before surgery as a pre-operative treatment.
For patients with peritoneal mesothelioma, radiation may be of limited use because of the presence of other vital organs in the abdominal cavity where the radiation will be directed.
One of the three cardinal approaches to mesothelioma treatment, chemotherapy provides excellent palliative care including the improvement in the patient’s quality of life and the prolongation of life expectancy. However, it should be understood that chemotherapy does not cure the cancer. Chemotherapeutic agents work in various ways. Generally, however, they kill cancer cells by altering their ability to replicate. This reduces the size of the tumor and at the same time help facilitate the removal of dead cancer cells. Unfortunately, chemotherapeutic agents do not show specificity for cancer cells. They also affect healthy, normal cells especially those that are rapidly dividing such as the hair and the skin.
Chemotherapeutic agents can be administered systemically or as a localized administration. Systemic administration are often indicated in mesothelioma patients suspected of being in an advanced stage of the cancer. Because the chemotherapeutic agent is distributed throughout the body, it is able to kill any breakaway cancer cells that may have already begun migrating or seeding to other parts of the body. Unfortunately, because it is systemic, the side effects are much more pronounced. For local administration of chemotherapeutic agents, it can be intrapleural or intraperitoneal, meaning the chemotherapeutic agents are administered directly into the affected pleura or peritoneum, respectively.
The chemotherapeutic agents of choice for mesothelioma include cisplatin, doxorubicin, and carboplatin although a combination of cisplatin and pemetrexed has been shown to increase the median survival time to 12.1 months compared to 9.3 for cisplatin-alone treatments. For patients with peritoneal mesothelioma, the efficacy of chemotherapeutic agents are enhanced by heating the solution first prior to administration into the peritoneum. This procedure, called hyperthermic intraperitoneal chemotherapy, or HIPEC, has been shown to increase median survival times.
Among generally-healthy individuals who have Stage I or II mesothelioma, surgery is not their best treatment option. Because they are in a generally better state of health, these individuals can respond a lot better to multimodal therapy that includes a combination of surgery, radiation therapy, and chemotherapy. The aim of multimodal therapy is to combine the benefits of the three cardinal therapeutic approaches to mesothelioma management. However, it is very important to understand that the success of the treatment is dependent on the presence of good prognostic indicators. Generally, an individual who is in Stage I or II and is in relatively good health is a good candidate for multimodal therapy.
One of the possible combination includes pleurectomy with intrapleural chemotherapy and thoracic irradiation followed by 2 cycles of chemotherapy. Another example is extrapleural pneumonectomy and chemotherapy.
The success of mesothelioma treatments is dependent on a variety of factors. One thing is very important, however – early detection means better treatment options which translates to better prognosis.