Multi-Modality Mesothelioma Therapy

Mesothelioma is a complex disease that requires more than one method of treatment. After years of testing combinations of therapeutic methods, the standard of mesothelioma therapy has become surgery, followed by radiation and chemotherapy.

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Surgical Approaches to Mesothelioma Therapy

The type of surgery that is performed as part of mesothelioma therapy depends on whether the intent is diagnostic, symptom alleviation, or in rare cases, curative. Surgery does carry with it the potential for significant complications, but it still is the best method of controlling the major symptoms of the disease and for tumor reduction. Doctors have managed to increase surgical survival rates by carefully screening patients to ensure they are good candidates for a particular procedure.

The following surgical procedures are used as part of mesothelioma therapy:

  • Thoracoscopy – This procedure is used to introduce an endoscope, an instrument for viewing inside body cavities, into the area that is suspected to contain disease.  It is primarily used to diagnose pleural fluid buildup to determine its cause, or to examine lesions.
  • Pleurodesis - This is a form of mesothelioma therapy used to alleviate shortness of breath associated with fluid buildup between the pleural layers. The fluid is completely drained and talc is introduced into the space to cause inflammation and the formation of scar tissue so that fluid cannot build up again.
  • Pleurectomy/decortication – The parietal pleura, which lines the chest wall, is stripped from the top of the lung to the diaphragm. The visceral pleura, which covers the lung, is then removed. This procedure can be used to manage fluid buildup or it can be for the purpose of either removing or debulking (removing as much as possible) the tumor.
  • Extrapleural pneumonectomy - This is a complex surgical procedure that removes the greatest amount of tumor and allows for high doses of radiation to be administered to the side of the thorax affected by the mesothelioma because the diseased lung is removed. In addition, both pleural layers, the sac around the heart, a large portion of the diaphragm and the nerve controlling its movement are also removed.

Adjuvant Radiation as Part of Mesothelioma Therapy

The dose of follow up radiation is determined by the need to irradiate the entire side of the thorax where the disease originated and by the need to protect adjacent organs from being damaged in the process. This makes it difficult to treat the entire pleural surface. However, this mesothelioma therapy has been shown to increase survival when used in conjunction with the other two therapies.

Adjuvant Chemotherapy as Part of Mesothelioma Therapy

In most instances, follow up chemotherapy consists of the drug combination of cisplatin (Platinol) and pemetrexed (Alimta). In cases where cisplatin is not recommended, another drug from the same drug classification, carboplatin, is used.

Complications of Mesothelioma Therapy

Researchers from the Division of Cardiovascular Disease, Department of Internal Medicine, at the University of South Florida College of Medicine reported on a case in which the patient was experiencing low blood pressure and a buildup of malignant pleural fluid under greatly increased pressure. A fluid buildup under pressure can cause a collapse of the respiratory and circulatory systems. In this instance, it caused a condition called tamponade, where the heart becomes compressed by the fluid buildup in the area between the heart muscle and the sac that surrounds the heart. The patient’s life was saved by a thoracentesis, a procedure that makes a puncture in the chest wall so that fluid can be drained.

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