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Treatment Options for Patients

Mesothelioma treatment depends on several factors, including the stage of mesothelioma, the location of the tumor, and the age and overall health of the patient.

1. Surgery - Removal of Malignant Mesothelioma
Surgical removal of the tumor and surrounding tissue may be used depending on how far the mesothelioma has spread (the stage). The more advanced the stage, the less likely that surgery will be effective in treating mesothelioma.

Surgery for malignant mesothelioma can be used for long-term control or to cure the disease (aggressive surgery) or can be used to relieve pain (palliative).

a) Aggressive surgery
Aggressive mesothelioma surgery involves removal of the pleura, lung, diaphragm, or pericardim. (The type involving removal of the pleura is called extrapleural pheumonectomy.) The goal is to remove as much of the mesothelioma tumor as possible. This type of surgery, also called extraplueral pneumonectomy, typically is performed on younger patients in Stage 1 of mesothelioma.

Because of the complexity and the high risks involved with this type of surgery, some mesothelioma hospitals do not perform the procedure. Also, different mesothelioma treatment centers may have different criteria for accepting patients for surgery. Therefore, it is important to check with a mesothelioma hospital to see if you meet its criteria.

b) Palliative Surgery
Palliative surgery is typically used in the more advanced stages of mesothelioma. The goal is to relieve or control symptoms caused by fluid collection or by the tumor compressing the lung or other organs. It is not intended to cure mesothelioma.

Pleurectomy/decortization is usually a palliative operation. It is used in situations where the entire tumor cannot be removed. It is effective in controlling the accumulation of fluid in the lungs (effusion), and the pain caused by mesothelioma.

Thoracentesis is also used to treat effusion in pleural mesothelioma. This treatment involves inserting a needle into the chest in order to drain the fluid. Thoracentesis does not involve surgical removal of the mesothelial cells.

2. Radiation
Radiation therapy uses high-energy x-rays to kill mesothelioma cancer cells and to shrink tumors. There are two types of radiation therapy.

External radiation therapy uses a machine outside the body that beams x-rays to the location of the mesothelioma.

Brachytherapy involves putting chemicals that produce radiation directly into the site of the mesothelioma cancer. This is done by inserting a thin plastic tube into the chest or abdomen.

Because of the location of malignant mesothelioma, it is very difficult to deliver high-enough doses of radiation to kill the tumor without damaging surrounding organs. As a result, it is unclear whether radiation therapy is a successful method of treating mesothelioma. It has, however, been effective in killing remaining tumor cells after surgery has been performed.

Radiation therapy is also used as a palliative therapy to relieve symptoms of mesothelioma, such as shortness of breath, chest pain, and internal bleeding.

Radiation therapy has several side effects, such as fatigue, nausea, and vomiting. Although these side effects are sometimes temporary, you should let your doctor know, since they often can be controlled.

3. Chemotherapy
Chemotherapy uses drugs to treat mesothelioma cancer. It is administered either orally (through pills) or by injecting the drugs directly into the veins (intravenously), the muscles, the chest cavity (intrapleurally), or the abdominal cavity (intraperitoneally). The goal of mesothelioma chemotherapy is for the drug to enter the bloodstream and circulate throughout the body in order to destroy the cancer cells.

Several drugs have been used, either individually or in combination with others, to treat mesothelioma. Some of the single-agent drugs include:

Adriamycin (doxorubicin), which is the most studied and, currently, the most effective single agent;

Single-agent therapy has been only modestly successful in treating mesothelioma, with studies showing a response rate in the 10 to 20% range.

Because of the relatively low response rate of single-agent therapy in treating mesothelioma, combinations of these drugs have been used to increase their effectiveness. Although some researchers have reported high response rates to these therapies, these rates have not been consistent, and more research is necessary.

Chemotherapy drugs are generally very toxic. Therefore, a doctor must be very careful in monitoring the condition of a patient during therapy. Some of the more common side effects include nausea, vomiting, loss or appetite, hair loss, and fatigue. Chemotherapy can also result in low blood cell counts, which increases the risk of infection and bleeding or bruising.

Side effects vary depending on the treatment, and generally disappear after treatment is completed.