Types of Traditional Care (surgery, Chemotherapy, and Radiation Therapy)

The key to long-term survival from treatment of mesothelioma is early diagnosis, which enables the greatest potential for success from standard therapies. Standard therapies include surgery, chemotherapy, and radiation therapy.

Surgery

Mesothelioma is diagnosed in stages that are defined by the extent of the cancer. There are four stages of mesothelioma ranging from “localized to one spot” to “metastasized throughout the body.” There are three traditional treatments for mesothelioma, surgery, chemotherapy and radiation therapy. These are used either alone or in combination to eliminate the cancer, to slow its progression, or reduce pain.

When conclusive diagnosis cannot be made from fluid samples, diagnosis is often made through a surgical procedure called a throrascopy. Thorascopy, while primarily a diagnostic procedure, offers an opportunity to administer a chemical pleurodesis treatment during the procedure. This treatment helps relieve fluid accumulated in the space between the two pleural layers. Other surgical approaches include video-assisted thoracic surgery, mediastinoscopy, and laparoscopy. These are primarily diagnostic procedures.

If mesothelioma is localized surgical removal of the tumor and nearby tissue may be the major part of therapy. Radiation therapy is often the preferred follow-up treatment to impede the growth of any cancer cells that remain after surgery.

A most promising treatment reported by Dr. David Sugarbaker of the Brigham and Women’s Center in Boston, Massachusetts shows a five-year survival rate of up to 40% of patients whose disease was diagnosed early. His aggressive, primarily surgical, treatment is changing the expected survival rate to a more promising prognosis.

Chemotherapy

Chemotherapy works by preventing cancer cells from dividing. Without division, the cancer can’t spread. Chemotherapy isn’t considered a curative treatment, so its goals are to stop or slow growth, to reduce the size of tumors in preparation for:

• their surgical removal

• for adjuvant therapy to destroy cells that remain after surgery, or

• palliative treatment aimed at relieving pain and other symptoms.

Metastatic pleural mesothelioma is being treated with Pemetrexed. Pemetrexed (Alimta) has been approved by the FDA as a “first-line treatment” for patients who are not surgical candidates. Pemetrexed was approved to be given in combination with Cisplatin for malignant pleural mesothelioma. While not a traditional chemotherapy, it is the new standard chemotherapy treatment.

Peritoneal mesothelioma is treated by a applying the chemotherapy directly into the abdomen. Called intraperitoneal chemotherapy, this is the delivery of cancer destroying drugs through a catheter directly into abdominal cavity through the abdominal wall.

Chemotherapy is usually given about every 21 days for a minimum of three to four cycles. Depending upon the effectiveness of these first treatments, cycles may be continued as long as tolerated and there is no disease progression.

Under chemotherapy we’ll include intraoperative photodynamic therapy. This therapy uses a drug that makes the cancer cells more sensitive to light. This drug is administered intravenously several days prior to the surgery. During the surgery the doctor shines a specialized light on to the now photosensitized cells to destroy them.

Radiation Therapy

Radiation therapy uses streams of radiation (x-rays) to destroy cancer cells in an effort to either control symptoms (palliative treatment) or in combination with surgery for more aggressive treatment.

Intensity modulated radiation therapy (IMRT) delivers radiation to irregularly shaped tumors or those very close to normal structures. Memorial Sloan-Kettering Cancer Center shows data supporting the reduction of local recurrence of mesothelioma by approximately 50%.

With IMRT, the radiation doses vary in intensity by following computer-generated images that precisely target the radiation to the cancer cells and reducing the exposure to adjacent tissues. Because of the precision, radiation therapy can be used on tumors that previously were considered too close to other organs to risk exposure to radiation.