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Treatment
The Mesothelioma treatment program 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.
Pleural effusion caused by heart failure or infection can usually be
resolved by directing treatment at the cause, however, when testing has
realized no diagnosis, and fluid continues to build or recur, doctors may
recommend chest tube drainage and chemical pleurodesis. Chemical pleurodesis
is a technique in which a sclerosing agent is used to abrade the pleural
surfaces producing an adhesion between the parietal and visceral pleurae.
This will prevent further effusion by eliminating the pleural space. Talc
appears to be the most effective agent for pleurodesis, with a success rate
of nearly 95%. It is highly effective when administered by either poudrage
or slurry. Poudrage is the most widely used method of instilling talc into
the pleural space. Before spraying the talc, the medical team removes all
pleural fluid to completely collapse the lung. After the talc is
administered, they inspect the pleural cavity to be sure the talc has been
evenly distributed over the pleural surface. Some doctors prefer to use talc
mixed with saline solution which forms a wet slurry that can roll around the
pleural cavity.
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.
Mesothelioma treatment
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.
Mesothelioma treatment
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.
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.
News on Mesothelioma treatment
December 3, 2004
A recent medical journal article by the
renowned oncologist, Dr. Nicholas Vogelzang, reviews the use of surgery and
other therapies to treat mesothelioma (Thorac Surg Clin. 2004 Nov; 14(4):
531–42). One operation, an extrapleural pneumonectomy, removes portions of
the lung, the parietal pleura (the lining of the lung), the pericardium
(the lining of the heart), and the diaphragm. A pleural decortication is
surgery that removes the lung lining or pleura only. Both surgeries can cut
out tumor cells, but the patient must be able to withstand the rigors of
these radical procedures.
The survival time after a diagnosis of mesothelioma may be as short as
several months. However, some mesothelioma patients who have received
extrapleural pneumonectomies have survived for over two years. Dr.
Vogelzang noted that the standard for treating mesothelioma may become the
use of surgery in combination with other therapies such as radiation and
chemotherapy. Early clinical studies have shown that chemotherapy followed
by surgery can aid in controlling mesothelioma.
Alimta® and Surgery
In February of this year, the Food and Drug Administration approved the
combination of a new drug, pemetrexed (Alimta®), plus a standard
chemotherapy agent, cisplatin, to treat patients with advanced mesothelioma
who were not good candidates for surgery. Alimta® works by blocking the
enzymes necessary for cancer cells to synthesize thymidine and purine. In
one study, 226 patients received pemetrexed and cisplatin, and 222 received
cisplatin alone. The median survival time in the pemetrexed/cisplatin group
was 12.1 months versus 9.3 months in the other group. Besides increasing
survival time, Alimta® also reduced pain. (See FDA Approves Alimta for more
details about this drug.)
In a future clinical trial, mesothelioma patients will receive pemetrexed
plus cisplatin followed by surgery and radiation. If the study shows a good
response rate and a survival time beyond 20 to 24 months, another study
will compare mesothelioma treatment with surgery and radiation to treatment
with surgery, radiation, and chemotherapy.
Mesothelioma | Mesothelioma Treatment | Mesothelioma Pathophysiology | Mesothelium definition | Mesothelioma Legal Issues | Mesothelioma Epidemiology | Mesothelioma Diagnosis | Mesothelioma definition | Mesothelioma Resources and links | Mesothelioma Treatment News | Mesothelioma Attorney | Asbestos Lung Cancer | Asbestosis definition | Pleura definition | Mesothelioma directory | Mesothelioma Real time News | Mesothelioma Treatment real time News