Pleural Mesothelioma Treatments
Patients with pleural mesothelioma have multiple treatment options that can improve their prognosis. While there are many possible approaches doctors may take, in general, there are 2 main procedures. Each is a multimodal approach, meaning it uses more than one treatment type.
Each procedure is different though both produce similar survival results. It’s up to the patient to decide which approach will work best for them after receiving consultation from a specialized mesothelioma doctor.
The first pleural mesothelioma treatment procedure is the extrapleural pneumonectomy (EPP) surgery.
Considered a more aggressive surgery, the EPP involves removing the diseased lung and the entire pleura, as well as a portion of the diaphragm and pericardium (lung lining).
Preventing Mesothelioma Metastasis
By removing the surrounding tissue, doctors get rid of areas that may have already been infiltrated by mesothelioma cells to prevent the risk of metastasis(spreading to other parts of the body).
Before surgery, patients may undergo chemotherapy to kill mesothelioma cells and improve the effectiveness of the surgery. This is called neoadjuvant treatment. Doctors may prescribe a combination of chemotherapy drugs, with cisplatin and pemetrexed being the most common formula.
During surgery, patients may also receive an injection of chemotherapy directly into the chest through a catheter. Administering chemotherapy during surgery helps kill any remaining cancer cells the surgeon couldn’t remove.
After surgery, all patients receive further rounds of chemotherapy. This is known as adjuvant treatment. Doctors may also give intensity modulated radiation therapy (IMRT), which is computerized radiation that sends pre-measured doses directly to the tumor site to kill off remaining mesothelioma cells.
EPP Treatment Results
Aggressive surgeries like the EPP procedure are only given to patients who are healthy enough to withstand the surgery and recovery. Multimodal treatment with EPP is an approach that can significantly improve a patient’s life expectancy.
Most studies show that patients can survive up to 2 years with this procedure, while some studies have shown a survival of nearly 4 years.
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Pleurectomy with Decortication
The second pleural mesothelioma treatment approach includes the pleurectomy with decortication (P/D) surgery. P/D is a lung-sparing surgery, in which doctors only remove the diseased pleura (lung lining) and leave the lung.
Lung-Sparing Surgery May Be Less Risky
Some experts consider this procedure to be less risky than the EPP and it may give the patient a better quality of life by allowing them to keep their lung.
Patients receive chemotherapy treatment before undergoing the P/D surgery to kill mesothelioma cells and help shrink the tumors.
Reducing the tumor’s size makes it easier for surgeons to remove the pleura and as much of the mesothelioma as possible during surgery.
After the surgery, patients remain on chemotherapy for several more weeks to further ensure surgical success and prevent recurrence (when the mesothelioma comes back). Patients may also receive radiation therapy to support the surgery.
P/D is a lung-sparing surgery where doctors only remove the diseased pleura (lung lining) and leave the lung.
P/D Treatment Results
The median life expectancy of patients who receive the P/D procedure is around 29 months.
Some studies have shown a high 5-year survival rate in stage 1 pleural mesothelioma patients. P/D has also shown to have a lower short-term post-surgery mortality rate. Fewer patients develop fatal complications during or within 30 days after surgery compared to patients who undergo EPP.