Mesothelioma Treatment

Treatment for mesothelioma depends on your health and the location of the cancer. Unfortunately, mesothelioma is very often aggressive and for most people cure is not possible. The disease is usually diagnosed in the advanced phase – when the cancer can no longer be removed by surgery. Instead, the doctor works to control your cancer in order to make you feel good. Some people want to do everything they can to get rid of cancer, even if it means lasting side effects, and at the start there is little chance of improvement. Others, however, prefer treatments that relieve their symptoms and make them more comfortable for the rest of their lives. Surgeons can remove mesothelioma when diagnosed at an early stage. In some cases, this leads to complete recovery. Sometimes it is not possible to remove the entire cancer. In these cases, surgery can help reduce the signs and symptoms caused by the spread of mesothelioma in your body.

Mesothelioma Treatment

Chemotherapy uses chemicals to kill cancer cells. It can reduce or slow the growth of mesothelioma that cannot be removed by surgery. It can also be used before surgery, to make surgery easier or after surgery, to reduce the likelihood that the cancer will return again. Radiotherapy uses high-energy rays in a specific area on your body. Radiation can alleviate signs and symptoms in people with pleural mesothelioma. It is sometimes used after surgery to prevent further spread of mesothelioma. Clinical trials are currently investigating a large number of targeted drugs. Targeted drug therapy uses drugs that attack specific abnormalities in cancer cells, but so far such therapies have not been sufficiently investigated.

Mesothelioma Stages which needs to treat

Although stages of the disease are distinguished, there is no standard treatment for malignant pleural mesothelioma. Very rarely, once a non-invasive PPM has been detected, it can be radically treated with surgery, chemotherapy and so-called intensity-modifying radiotherapy. Surgery is technically very complicated because of the need to remove the entire lung, parietal and visceral pleura, pericardium, and part of the diaphragm. Chemotherapy-only therapy is recommended for non-operative patients with stage four mesothelioma or the histologic type of mesothelioma. Chemotherapy may also be given before or after surgery. In practice, most patients receive chemotherapy and, when available, intensity-modifying radiotherapy. The most effective chemotherapy for PPM is the combination of pemetrexed and cisplatin (or carboplatin) (for up to 6 courses). Folic acid and vitamin B12, sufficient fluids, are used to reduce drug toxicity. Other available options include the combination of cisplatin and gemcitabine, pemetrexed or vinorelbine monotherapy. Second-line chemotherapy may be given with the above drugs as long as they have not been given first-line chemotherapy, less frequently doxorubicin, raltrexed, methotrexate or a combination of mitomycin, vinblastine, cisplatin. Mesothelioma, which has spread to the surrounding organs, is treated symptomatically. To reduce fluid retention in the pleural cavity, pleurodesis (usually talc) by thoracoscopy or removal of fluid through a long-term catheter in the pleural cavity is recommended. Folate and vitamin B12, sufficient fluids, are used to reduce drug toxicity. Other available options include the combination of cisplatin and gemcitabine, pemetrexed or vinorelbine monotherapy. Second-line chemotherapy may be given with the above drugs as long as they have not been given first-line chemotherapy, less frequently doxorubicin, raltrexed, methotrexate or a combination of mitomycin, vinblastine, cisplatin. Mesothelioma, which has spread to the surrounding organs, is treated symptomatically. To reduce fluid retention in the pleural cavity, pleurodesis (usually talc) by thoracoscopy or removal of fluid through a long-term catheter in the pleural cavity is recommended. Folic acid and vitamin B12, sufficient fluids, are used to reduce drug toxicity. Other available options include the combination of cisplatin and gemcitabine, pemetrexed or vinorelbine monotherapy. Second-line chemotherapy may be given with the above drugs as long as they have not received first-line chemotherapy, less frequently doxorubicin, raltrexed, methotrexate or a combination of mitomycin, vinblastine, cisplatin. Mesothelioma, which has spread to the surrounding organs, is treated symptomatically. To reduce fluid retention in the pleural cavity, pleurodesis (usually talc) by thoracoscopy or removal of fluid through a long-term catheter in the pleural cavity is recommended. Second-line chemotherapy may be given with the above drugs as long as they have not been given first-line chemotherapy, less frequently doxorubicin, raltrexed, methotrexate or a combination of mitomycin, vinblastine, cisplatin. Mesothelioma, which has spread to the surrounding organs, is treated symptomatically. To reduce fluid retention in the pleural cavity, pleurodesis (usually talc) by thoracoscopy or removal of fluid through a long-term catheter in the pleural cavity is recommended. Second-line chemotherapy may be given with the above drugs as long as they have not been given first-line chemotherapy, less frequently doxorubicin, raltrexed, methotrexate or a combination of mitomycin, vinblastine, cisplatin. Mesothelioma, which has spread to the surrounding organs, is treated symptomatically. To reduce fluid retention in the pleural cavity, pleurodesis (usually talc) by thoracoscopy or removal of fluid through a long-term catheter in the pleural cavity is recommended.

Mesothelioma Stages

In stage I , the tumor is confined to the parietal pleura and is not present in the lymph nodes; in stage II , in addition to the parietal pleura, it involves the visceral pleura (the membrane in direct contact with the lung) and the lung itself or the diaphragm; in stage III the tumor has invaded the first layer of the thoracic wall, part of the mediastinum or a point of the thoracic wall; it can affect the external surface of the pericardium and the lymph nodes of one of the two sides of the thorax; inStage IV the tumor has reached other organs (metastases) such as liver, brain, bones or lymph nodes on both sides of the chest.

For peritoneal mesothelioma there is a shared staging system, and apply the principles of the TNM system above to pleural mesothelioma.
In general, the earlier the tumor stage is at the beginning of the therapy, the better the prognosis; however, in the case of mesothelioma, complete recovery is very rare. Therefore, the primary goal of therapy is to control symptoms in order to allow an acceptable quality of life.

Treatment of Mesothelioma

As with all types of cancer, the treatment of mesothelioma is based on the three traditional methods – surgery , radiotherapy and chemotherapy – alone or in combination. It is important to keep in mind that every patient is a case in itself, because tumors that have very similar histological features can grow differently in different subjects and give rise to different symptoms. Similarly, a treatment that works in one subject may not work the same way in another subject.

Mesothelioma Surgery :

Mesothelioma Surgery

it is not considered very successful, especially if used alone, while the chances of success increase if combined with radiotherapy and chemotherapy. The most widely practiced surgical procedure is pleurectomy , which means the removal of more or less extensive pleural tracts. Less frequent is the practice of more destructive interventions such as extra-pleural pneumonectomy in which the surgeon removes the lung, the pleura, part of the chest wall and, if necessary, part of the diaphragm and the pericardium. The main goals of surgery in the treatment of malignant pleural mesothelioma (which considers the structure of a multimodal approach) is the resection of all macroscopic disease along with the delivery of chemotherapy and radiation. The surgical options available to achieve this aim include extrapleural pneumonectomy, pleurectomy / decortication and in some cases surgical pleurodesis via video assisted thoracoscopic surgery.

Some medical centers recommend pleurectomy / decortication as a method of choice for patients with impaired heart or lung function, old age or certain comorbidities, to eliminate tumor mass while saving lung function at the same time. Proper knowledge of the similarities and differences between all the aforementioned techniques is key in understanding the complex issues surrounding patient selection, adequate diagnosis, organization, preoperative assessment, perioperative management as well as auxiliary treatment.

Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion represents a standard approach for resectable peritoneal mesotheliomas. Pericardiectomy may be attempted for pericardial mesotheliomas, but the procedure is often unsuccessful because the pericardium can be densely adherent to the myocardium.

Mesothelioma Radiotherapy

Mesothelioma Radiotherapy

Takes place after surgery, possibly in combination with chemotherapy, provided that the mesothelioma is localized and the patient’s condition allows radical surgery. The purpose of the combined treatment with radiotherapy and chemotherapy after surgery is to consolidate the effects of surgery, prolonging life expectancy which in some cases can even exceed 5 years. Although mesothelioma is considered rather resistant to radiotherapy alone, it can be used for palliative purposes to resolve the consequences of tumor growth (typically, the obstruction of a large blood vessel) or to reduce pain due to infiltration of the wall chest. Unfortunately, it is not possible to consider radiotherapy as the only therapeutic treatment, because the required dose would be very high and therefore highly toxic for any patient.

Radiotherapy is frequently used to manage local tumor growth; an occasional regression of the disease can be seen, although there is no evidence that radiation therapy alone can affect survival rates. Therefore it is usually used as a part of the multimodal approach, most often combined with surgery.

In administering radiotherapy as an auxiliary therapy after the extrapleural surgical pneumonectomy or pleurectomy / decortication, patients are usually treated with conventional radiation techniques using the anterior and posterior fields which include the entire part of the chest leading with the disease. Highly complex intensity-modulated radiotherapy techniques (IMRT) allow more effective saving of normal tissues, thus providing safer and less toxic treatment with better efficacy. The highest radiation doses of this way are also delivered to the target of the tumor. Helical arc therapy or tomotherapy is rotational radiotherapeutic methods that deliver radiation from even more opening angles. Radiotherapy has a limited role in peritoneal mesothelioma, so it is not used in most medical centers. Treatment for advanced primary pericardial mesothelioma is usually palliative due to the resistance of tumors to radiation therapy and chemotherapy.

Mesothelioma Chemotherapy

Mesothelioma Chemotherapy

Aaccording to some relatively recent clinical studies, it can be considered as the only treatment able to prolong the life of the patient, also improving its quality. The drugs commonly used, individually or, more often, in combination are pemetrexed (Alimta┬«) and cisplatin, in addition to carboplatin, raltitrexed (Tomudex┬«), mitomycin, vinorelbine and gemcitabine. All chemotherapy drugs have side effects that can be very serious and debilitating. Among these the most common are: reduction of blood cells, malaise, vomiting and diarrhea, ulcerative lesions of the oral cavity, loss of hair and hair, fatigue.
For patients who do not tolerate pemetrexed an alternative may be the combination of cisplatin-gemcitabine or vinorelbine; to those who do not tolerate cisplatin it is possible to administer carboplatin without differences in survival.

However, many unknowns remain about chemotherapy, mainly on the advisability of starting it immediately with the diagnosis or appearance of symptoms related to the tumor, and on the number of cycles to be performed (only the classic 6 or continue with a maintenance with a single drug, generally the pemetrexed, which is the most active and the least toxic?).

Malignant mesothelioma represents a rare disease, most often associated with occupational exposure to asbestos, with a constant increase in incidence worldwide. Mesotheliomas are almost universally considered to be internal malignancy and to date the treatment options were limited and often ineffective. Current treatment modalities for malignant mesothelioma can be classified in radiotherapy, chemotherapy and radical procedures as surgery. Palliative measures are also often used for the primary purpose of eliminating pleural effusions and preventing their recurrence; therefore symptoms such as chest pain and dyspnea (in cases of pleural mesothelioma) can be alleviated.

Monotherapy with single cytotoxic drugs rarely provides significant results in the treatment of malignant pleural mesothelioma, but the combination regimens with new drugs and standard molecules are showing the best clinical answers and advantages. According to the results of phase II / III studies, pemetrexed (a multitarget folic pathway inhibitor) together with platinum derivatives and the gemcitabine / cisplatin associations represent first-line chemotherapy. Vinorelbine as a single agent and combination of mitomycin C, vinblastine and cisplatin has also been validated as a good symptom relief approach with acceptable toxicity. Histone deacetylase inhibitors and antiangiogenic agents also show considerable promise as targeted therapies, but they are still to reach daily practice.

Chemotherapy plays an important role in the palliative care of peritoneal mesotheliomas. It can be administered systematically or directly in the abdomen, with continuous hyperthermic peritoneal perfusion showing the best response rate of 84.6%. The studied agent is cisplatin with proven activity in a quarter of all patients.

Leave a Reply

Your email address will not be published. Required fields are marked *