Mesothelioma Treatment

Mesothelioma Treatment Information
treatment of malignant mesothelioma
GENERAL Rx
• Operable patient (epithelial type, no positive nodes, confined to pleura, adequate PFTs): the two surgical techniques for therapeutic intervention are decortication (pleurectomy) and extrapleural pneumonectomy. Postoperative chemotherapy with cisplatin, doxorubicin, and cyclophosphamide and subsequent external beam radiation are used in some centers with limited success.

• Inoperable patient (disease too extensive, sarcomatous or mixed histology type, poor PFTs): supportive care plus/minus radiation therapy for symptoms or supportive care plus chemotherapy. Combined modality therapies (surgery, radiation therapy, chemotherapy, and biologics) have also been used to reduce both local and distant recurrences. The combination of pemetrexed (an antimetabolite that inhibits enzymes involved in folate metabolism) and cisplatin is used for chemotherapy of unresectable malignant pleural mesothelioma .



• Intrapleural instillation of cisplatin or biologics (e.g., interferons, interleukin-2) is generally limited to very early disease because it can only penetrate a very limited depth of the tumor and there is a propensity of the pleural space to become progressively obliterated with advancing disease.

• The role of radiation therapy in the treatment of mesothelioma remains uncertain. It is often used for palliation of local pain despite lack of trials to prove its utility.

• Obliteration of the pleural space (pleurodesis) with instillation of tetracycline, bleomycin, or biologic substances such as C. parvum into the pleural cavity is often tried in attempting to treat recurrent symptomatic pleural effusions.

DISPOSITION
Median survival for patients undergoing pleurectomy ranges from 6.7 to 21 mo, for extrapleural pneumonectomy 4 to 21 mo. Survival is better for patients with epithelial form.
Mesothelioma Treatment Information
Mesothelioma Cancer