SOME OPTIONS FOR MESOTHELIOMA TREATMENT
MESOTHELIOMA TREATMENT OPTIONS
The treatment program for
mesothelioma depends on many factors, including: the stage of the cancer, where
the cancer is, how far the cancer has spread, how the cancer cells look under
the microscope and the patient’s age and desires.
TIME MATTERS
People diagnosed with this disease
are often told the expected survival time is only eight to twelve months.
However, specialists in treating malignant mesothelioma at the leading cancer
centers often have better statistics.
For instance, the five-year survival
rate has approached 40% for selected patients of Dr. David Sugarbaker at
Brigham and Women’s Center in Boston. To qualify for Dr. Sugarbaker’s treatment
you must meet certain criteria. One of them is being in the early stages of the
disease, so time is of the essence. To find out more about Dr. Sugarbaker and
other physicians and cancer centers specializing in mesothelioma click on Finding Specialists.
Keeping track of your medical
treatment is useful and a personal medical records file can help.
TRADITIONAL CARE
There are three traditional kinds of
treatment for patients with malignant mesothelioma:
- Surgery (taking out the cancer)
- Chemotherapy (using drugs to fight the cancer)
- Radiation Therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)
Often two or more of these are
combined in the course of treatment.
Diagnostic Procedures
As previously mentioned in the “Symptoms” section of this website, a diagnosis of
mesothelioma from fluid is many times inconclusive. Given this fact, diagnostic
surgery becomes a necessary next step in confirming and staging mesothelioma.
Thoracoscopy enables a physician to evaluate the pleural cavity and to
conduct multiple tissue biopsies under direct vision. In up to 98% of cases, a
definitive diagnosis can be obtained. Often, chemical pleurodesis aimed at
relieving the accumulation of fluid in the intrapleural space, can be
accomplished during the same procedure. It is also possible to gauge the extent
of the tumor, and make a determination of surgical resectability. While less
invasive than an open biopsy, it can only be performed on patients where tumor
has not obliterated the pleural space.
VATS, or video-assisted thoracic
surgery is an alternative to thoracoscopy,
although because of its more invasive nature, concerns of tumor seeding
increase. By utilizing small incisions, the physician can view the pleural
space with the assistance of a camera, and obtain sufficient tissue samples for
analysis by a pathologist. Extent of the tumor (i.e., pleural involvement,
chest wall invasion) may also determined, and recommendation as to the type of
debulking procedure necessary can be made at this time.
Mediastinoscopy is sometimes used as an aid in staging extent of disease
when enlarged nodes are seen using imaging techniques.
Laproscopy is used in mesothelioma patients in cases where imaging
techniques suggest possible invasion of the tumor through the diaphragm. This
information can be important in evaluating a patient for potential pleurectomy
or extrapleural pneumonectomy.
Palliative Procedures
Palliative surgical procedures are
those which treat a symptom of mesothelioma, without aggressively
treating the disease itself.
Chest Tube Drainage and Pleurodesis is considered the most common of palliative treatments.
Fluid build-up, or pleural effusion, is most often the first symptom which will
prompt mesothelioma patients to seek medical attention. Once this effusion has
occurred, it is many times persistent, returning rapidly after initial
thoracentesis (draining of the fluid). In order to eliminate this problem, the
pleural space must be closed. This is accomplished by use of a talc slurry or
other sclerosing agent which produces an adhesion.
Thoracoscopy and Pleurodesis is done in conjunction with VATS using a powdered form of
talc versus talc slurry. Both this and chest tube drainage and pleurodesis will
be only effective if there is no tumor encasing the lung which restricts its
expansion.
Pleuroperitoneal Shunt plays a limited role in palliation for several reasons. It
involves placement of a catheter run under the skin from the pleural to the
peritoneal cavity. Obstruction of the catheter and possible seeding of the
tumor into the abdominal cavity may be concerns.
Pleurectomy, used as a palliative procedure, may be performed where
more extensive surgery is not an option. In these cases, it is understood that
all visible or gross tumor will not be removed. It is considered the most
effective means of controlling pleural effusion in cases where the lung’s
expansion is restricted by disease.
Potentially Curative Procedures
These procedures are performed with
“curative intent”. Their goal is removal of all gross disease, with the
knowledge that microscopic disease will most likely remain. Adjuvant therapy
(another form of treatment in addition to the primary therapy) is typically
aimed at eliminating residual disease.
For Pleural Mesothelioma:
- Pleurectomy/Decortication is usually performed on patients with early stage disease (Stage I and selected Stage II), and attempts to remove all gross tumor. If it is found that all tumor can not be removed without removing the lung, this may be done at the same time and is called pneumonectomy.
- Extrapleural Pneumonectomy is considerably more radical than other surgical approaches, and should be carried out by surgeons with great expertise in evaluating patients and performing the procedure itself. (See Finding Specialists.) Because in the past surgery alone has failed to effect a cure, or even to help prolong life for any extended period of time, it is currently being combined with traditional chemotherapy and/or radiation, or other new approaches such as gene therapy, immunotherapy or photodynamic therapy.
General Patient Selection Criteria
for Extrapleural Pneumonectomy
Extrapleural pneumonectomy is a
serious operation, and doctors experienced in this procedure choose their
patients carefully. It is up to each individual surgeon to advise the patient
on its feasibility and to conduct whatever tests he/she feel are necessary to
optimize the patient’s chances for survival and recovery. Following is a
general list of patient selection criteria. This list may not be all inclusive,
and may vary according to the preference of the surgeon.
- Karnofsky Performance Status score of >70. This score relates to what symptoms of disease the patient may be experiencing and how well they are able to conduct their daily activities. Some surgeons may require a higher performance status than others.
- Adequate renal (kidney) and liver function tests; no significant kidney or liver disease.
- Normal cardiac function per electrocardiogram and echocardiography.
- Adequate pulmonary function to tolerate the surgery.
- Disease limited to the ipsilateral hemithorax (the same side of the chest in which the mesothelioma is located) with no penetration of the diaphragm, extension to the heart or extensive involvement of the chest wall.
- Age of the patient is taken into consideration, but may not be as important as their overall status.
Surgeries of this nature should
always be done with a complete understanding of the possible benefits and risks
involved. If you are considering surgery as a treatment option, speak openly
with your doctor about your concerns, and be sure all of your questions are answered to
your satisfaction.
For Peritoneal Mesothelioma:
- Cytoreductive Surgery is aimed at removing all or nearly all of the gross or visible tumor in the peritoneal cavity. In order to treat any remaining cancer cells, Intra-Peritoneal Hyperthermic (heated) Chemotherapy (IPHC) is then delivered to the abdominal cavity. The type of chemotherapy drug used may vary according to the physician’s preference.
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Treatment
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