Three traditional kinds of treatment exist for patients with malignant mesothelioma: surgery which removes the cancerous masses from the body, chemotherapy, which uses a variety of potent drugs to kill the cancer, and radiation therapy, which uses high doses of x-rays to kill the cancer cells. Oftentimes, doctors use two or more of these treatment courses together to maximize the likelihood of success.
Several types of surgery exist for treating mesothelioma. A pleurectomy/decortication removes part of the chest or abdominal lining and the surrounding tissue. Doctors most often use the pleurectomy as a palliative procedure to relieve pain and prevent pleural effusion, or the build-up of fluid between the lungs and the chest cavity. While a surgeon can remove a good deal of the tumor through pleurectomy, the procedure often leaves mesothelioma along the diaphragm and lungs. A more aggressive surgery, known as pneumonectomy, removes an entire lung in order to remove the mesothelioma. In extrapleural pneumonectomy the surgeon removes the affected lung along with the lining and diaphragm on the affected side and the lining around the heart.
Chemotherapy uses drugs to kill cancer cells. Doctors may administer chemotherapy by pill or through a needle into a vein or muscle. Doctors can administer chemotherapeutic agents either systemically (through the blood stream) or intrapleurally (in the pleural cavity). When administered intrapleurally, the chemotherapy treatment is localized at the site of the tumor. The drugs used for chemotherapy are generally very toxic and are usually accompanied by serious side effects including nausea, vomiting, anorexia, hair loss, and exhaustion. Side effects vary depending on the particular drugs used for the chemotherapy.
Single-agent therapy utilizes only one drug in the chemotherapy regimen to treat the cancer. Several agents have demonstrated modest success in effectively treating mesothelioma. Doxorubicin, probably the most extensively studied agent, has a response rate in the 15 percent range, as do detorubicin, pirarubicin, and epirubicin. Other agents, such as carboplatin, mitomucin, cyclophosphamide, and ifosdamide have similar response rates ranging from 10 to 20 percent. Researchers have studies cisplatin in a number of trials and discovered an approximately 14 percent response rate. One small study of very high dose-intensity cisplatin demonstrated a 36 percent response rate, but the high responsiveness lasted only 2 to 8 months.
Because single-agent chemotherapy regimes have failed to show great effectiveness (response rates less than 20 percent), researchers have examined several combination regimens for treatment of patients with mesothelioma. Combinations including doxorubicin, cisplatine, mitoxantrone, and bleomycin have been reported to realize response rates of up to 44 percent. Such high response rates have not been consistent, and overall combination therapy yields response rates similar to singe-agent therapy.
A new agent, gemcitabine, in combination with cisplatin has showed promising results in a study conducted by Australian researchers. In their research, which included mesothelioma patients in Stages III and IV, the combination therapy reaped a 47 percent response rate with a response duration of 25 weeks. The researchers reported a one-year survival rate of 41 percent with this treatment.
Pemetrexed, a multitargeted antifolate (MTA) has shown promising results when combined with cisplatin. In addition, researchers are currently conducting promising studies of oxaliplatin/
raltitrexed and cisplatin/irinotecan combinations. Other new agents researchers are now studying include bevacizumab and onconase both of which are considered novel drug treatment options.
With each new therapy development, doctors have another therapy tool with which to treat patients. The increase in options allows doctors and patients to more carefully tailor a chemotherapy regime that addresses the specific needs of the patient, including the stage of the mesothelioma and the patient's age.
In radiation therapy doctors use high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).
Doctors sometimes use radiation therapy as the main treatment for mesothelioma for patients who might not be well enough to have surgery. Doctors also use radiation in combination with surgery, or as a way to ease symptoms such as shortness of breath, pain, bleeding, or trouble with swallowing.
There can be side effects from radiation. The skin in the area treated may look sunburned and then become darker. Most of these will go away after a short while.
If fluid collects in the chest or abdomen, a doctor may drain the fluid out of a patient's body by putting in a needle into the chest or abdomen and using gentle suction to remove the fluid. The removal of fluid from the chest is called thoracentesis. The removal of fluid from the abdomen is called paracentesis. After these procedures, a doctor may also put drugs through a tube into the chest to prevent additional fluid from accumulating.
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