Mesothelioma Treatment Types
Standard treatment for mesothelioma takes the form of surgery, chemotherapy, and/or radiation.
While surgery is usually part of life-extending treatment plans, not all patients are good candidates for these aggressive procedures.
For example, some patients may have extensive cancer or a disease that has spread, be unable to tolerate surgery, or have cancers that cannot be removed. Such individuals may be given chemotherapy or radiation to try and shrink tumors and slow their growth.
The different treatment types are most effective when at least two of them are used together.
The single most effective way to control the growth of mesothelioma and extend a patient’s life is through mesothelioma surgery.
According to Surveillance, Epidemiology, and End Results (SEER) program data collected by the National Cancer Institute (NCI), the median survival time for pleural mesothelioma patients with an epithelial cancer cell type increased with surgery.
Those who underwent surgery survived for 19 months after diagnosis. By comparison, the median survival of patients who did not receive treatment was 12 months.
Doctors have developed surgical procedures for different types of mesothelioma. Which surgery (if any) a doctor recommends depends on what type of mesothelioma a patient has and how far it has spread.
Most Common Mesothelioma Surgeries
||Extrapleural pneumonectomy (EPP)
||Removal of the diseased lung and pleura
||Pleurectomy with decortication (P/D)
||Removal of the diseased pleura and any visible tumors
||Cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC)
||Removal of all visible cancer in the abdomen followed by the direct application of chemotherapy drugs into the abdomen
||The removal of tumors by removing part or all of the lining of the heart
During surgery, doctors cut open the chest or abdomen and physically remove all visible tumor masses. In some cases, they also remove surrounding tissues or organs. In most cases, surgery is only used if a patient is strong enough to fully recover.
Doctors rarely treat mesothelioma with surgery alone, even when surgery is possible. Chemotherapy and/or radiation play a key role in destroying as much of the cancer as possible.
During mesothelioma chemotherapy, doctors circulate specialized drugs through a patient’s body to kill cancer cells. Chemotherapy is a common treatment for mesothelioma — by itself and combined with surgery.
Chemotherapy for mesothelioma may be used to:
- Kill remaining cancer cells after surgery
- Reduce tumor size
- Slow the spread of mesothelioma
- Treat patients who cannot have surgery
Doctors usually recommend multiple rounds of chemotherapy to kill as many cancer cells as possible. According to the American Cancer Society (ACS), mesothelioma patients are usually given a combination of the drugs cisplatin and pemetrexed.
Depending on the treatment approach, chemotherapy may be given before, during, or after surgery to increase the chances of long-term remission. However, patients may experience negative side effects from chemotherapy drugs, such as fatigue, hair loss, and nausea.
Using powerful electromagnetic waves, radiation therapy for mesothelioma scrambles the DNA of mesothelioma cells, killing them.
Radiation therapy for mesothelioma may be used to:
- Kill remaining cells at the tumor site after surgery
- Shrink tumors to make surgery easier
- Prevent mesothelioma cells from being spread around the body during surgery
Radiation is usually used alongside other forms of mesothelioma treatment.
Targeted therapy is a new type of therapy that treats cancer with drugs designed to zero in on cancer cells, stopping them from reproducing or signaling them to destroy themselves while leaving normal cells alone.
Targeted therapy is different from traditional chemotherapy in two main ways:
- Targeted therapy leaves most healthy cells untouched, only affecting cancer cells. Traditional chemotherapy damages some healthy cells as well, causing negative side effects. Targeted therapy typically has fewer and different side effects than chemotherapy.
- Targeted therapy often works by stopping cancer cells from reproducing or making them change. Traditional chemotherapy aims to destroy cancer cells.
As researchers learn more about mesothelioma and the particular traits of its cancer cells, targeted drugs should become increasingly effective at stopping the disease in its tracks without harming patients.
According to the NCI, certain mesothelioma patients may now receive targeted therapy as part of their treatment plan. However, they will likely need other treatments such as traditional chemotherapy as well.
In addition, several targeted therapy drugs are being tested for mesothelioma, which patients may access in clinical trials.
While surgery, chemotherapy, and radiation are key mesothelioma treatments, they are most effective when used alongside one another. When two or more mesothelioma treatments are used together, it is known as multimodality therapy.
In most multimodal therapy plans, different forms of treatment are administered one after the other. For example, a patient may undergo surgery to remove visible cancer tumors and then undergo chemotherapy to kill microscopic cancer cells.
Doctors may apply several multimodal treatments in the process of surgery:
- Before surgery: Patients may undergo neoadjuvant (pre-surgery) chemotherapy — a process used to kill mesothelioma cells and shrink tumors, improving the effectiveness of the surgery.
- During surgery: Patients may also receive an injection of heated chemotherapy directly into the abdominal or chest cavity through a catheter immediately after surgery.
- After surgery: Doctors may give intensity-modulated radiation therapy (IMRT) or other focused radiation treatments, which involve computerized radiation that send pre-measured doses directly to the tumor site to kill off remaining mesothelioma cells.
Different treatment combinations may be used depending on the type of mesothelioma and the patient’s overall health.