The conventional treatments for Mesothelioma are often used in combination with one another to further maximize their effectiveness.
The three most common treatments are surgery, radiation and chemotherapy. A physician may follow surgery with a combination of radiation and chemotherapy to kill any residual cancer cells that may be lingering after the surgery.
Surgery and its accompanying treatments are a curative process. A physician will opt for curative treatments when the cancer is diagnosed early.
Alternately, palliative treatment is the process used when the cancer has advanced too far for surgery to be effective. Palliative treatments are usually applied to ease patient’s pain or improve the quality of life. Radiation therapy may be used as a curative or palliative treatment modality.
Common Treatment Options
Surgery, which is the most common treatment, has not been highly successful in treating mesothelioma. For malignant cases the life expectancy may be 6 – 12 months. Pleurectomy/decortication, where the lining of the chest is removed, is most common. Extrapleural Pneumonectomy (EPP) is less common and the lung is removed, the lining of the inside of the chest, diaphragm and pericardium are removed.
The three main types of radiation therapy are external beam radiotherapy, unsealed source radiation therapy, and brachytherapy:
- External Beam Radiotherapy: This is usually a palliative treatment, requiring the patient to sit or lie under the direction of a radiation beam that treats the affected area. Its purpose is to kill tumor cells and slow down the rate of growth, however, it has not been determined that all tumor cells should be killed. External beam radiotherapy may also be used with surgery or chemotherapy
- Sealed Source Radiation Therapy: Also known as brachytherapy, sealed source radiation therapy consists of implanting very tiny radioactive rods or “seeds” within one centimeter of the tumor. Radiation can be delivered to malignant mesothelioma cancer cells with greater accuracy while healthy tissues receive very little radiation and the patient experiences reduced side effects. The radioactive seeds are implanted and continue to emit radiation for a short term of a long term which may be six to twelve months.
- Unsealed Source Radiation Therapy: The patient receives an oral dose or an injection of a radioactive substance. This treatment poses a health threat to others and is not a curative treatment for mesothelioma.
Chemotherapy is the treatment of cancer using chemicals that cells, specifically those of micro-organisms or cancer. The United States Food and Drug Administration( FDA) has approved Pemetrexed (brand name Alimta) for treatment of malignant pleural mesothelioma which is administered in combination with Cisplatin, a platinum-based drug used to treat various cancers, lymphomas and germ cell tumors.
Considered an experimental therapy for mesothelioma, immunotherapy is becoming more commonly used to treat the disease by stimulating the patient’s immune system to counteract the onset of cancer.
Medicines know as Biological Response Modifiers are manufactured synthetically and used in this treatment. In a clinical trial, the intrapleural inoculation of Bacillus Calmette-Guerin, the mesothelioma responded to immunotherapy, but patients exhibited major side effects. In another clinical trial, interferon alpha produced minimal side effects and 20% of patients experienced a 50% reduction in tumor masses.
Other Treatment Options
- Photodynamic Therapy: This new form of treatment involves the intravenous injection of photosensitive drugs to kill the cancer cells.
- Gene Therapy: This treatment attacks the cancer on the DNA level. There are two types: Replacement Gene Therapy involves the replacement of the bad gene affecting the cancer is with a new gene.
- Knockout Gene Therapy: This treatment option involves the complete removal of the bad gene from the DNA.
- Heated Intraoperative Intraperitoneal Chemotherapy: In this treatment modality, a surgeon removes as much of the tumor as possible, then administers chemotherapeutic drugs in high doses into the abdomen and the pelvis surface. The drugs are heated to better penetrate the tissue and kill the cancer cells. The fluid is drained in 1 – 2 hours.
Palliative therapies may be used to improve the patients discomfort or to reduce pain.
- Chest Tube Drainage: In this procedure, excess fluid is drained from the chest by thoracentesis or inserting a thin needle between the ribs or paracentesis inserting the needle into the abdomen. Drugs may be administered to prevent further accumulation of fluid.
- Pharmacological Therapy: This treatment strategy is simply the use of pain medications, such as non-opioid pain relievers, opioid pain relievers, and other drugs to help control the effects of mesothelioma.
- Pleuroperitoneal Shunt: This procedure involves the use of a catheter under the skin from the chest area to the abdomen. Side effects may be the catheter becomes obstructed or a tumor may find is way to the abdomen through the tube.