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Peritoneal Mesothelioma Treatment

Peritoneal Mesothelioma Treatment

Peritoneal mesothelioma is a rare cancer that develops in the lining of the abdomen, with only about 250 new cases diagnosed in the United States each year. Peritoneal mesothelioma patients have a typical life expectancy of one year or less, which is slightly shorter than the average pleural patient's. This short life span is largely because of the lack of viable treatment options. However, some treatment options may help lengthen life expectancy and improve quality of life.

Peritoneal mesothelioma is usually only diagnosed after it is widespread in the body. Because curative treatments are not effective once the cancer has spread, recommended treatment tends to focus on alleviating symptoms rather that attempting to cure the cancer.Treatment options usually include surgery and chemotherapy, which have been proven effective at relieving symptoms. Some doctors may also recommend radiation therapy. However, this is a rare treatment for peritoneal mesothelioma because the cancer's location in the abdominal region means that vital organs such as the small intestine, liver and kidneys will receive harmful radiation. Most doctors recommend a combination of two or more treatment options. This combination, called multimodal therapy, has shown the best results among patients because the treatments work together to remove cancer growth and prevent recurrence better than one treatment alone.Many patients also turn to clinical trials, which often give patients access to top new treatment methods.

Certain biological factors may affect treatment options as well as the efficacy of those treatments. If the cancer is in an earlier stage, it is usually smaller and more localized, making it easier to treat. Conversely, if the tumor growth is widespread, treatments will have little effect on controlling the growth. The patient's overall health also affects treatment options. Patients with no other major health problems are usually better candidates for extensive treatments including surgery. Other factors that may affect treatment are age, gender, presenting symptoms, cellular makeup of the tumor and additional features.

If you've been diagnosed with peritoneal mesothelioma, learn more about your treatment options. The Mesothelioma Center offers a complementary packet with information about peritoneal mesothelioma, treatment options and top doctors. Request a personalized packet by filling out the form on this page.

Surgery

Surgery is one of the most common treatments for any type of mesothelioma. Certain surgical options are available only for peritoneal mesothelioma patients, as they focus on abdominal malignancies. Each operation has a different purpose. Depending on each patient's particular needs, surgeons may consider one of the following procedures.

Peritonectomy

Peritonectomy is the most commonly performed surgery for peritoneal mesothelioma. During a peritonectomy, the surgeon removes the cancerous area of the lining of the abdomen. This operation aims to remove all visible cancer growth. When combined with chemotherapy, this procedure may help improve life span in some patients. However, peritonectomy is predominantly used to relieve the pressure caused by the tumor and reduce symptoms such as abdominal pain.

Cytoreductive Surgery

Immunotherapy pleural mesothelioma

Cytoreductive surgery is the combination of multiple peritonectomy procedures in order to remove as much of the cancer as possible. This operation includes as many as six different peritonectomy procedures, which each focus on a distinct part of the abdomen. Depending on tumor locations, debulking may include removing parts of the gall bladder, bowels, spleen, liver and stomach. Like peritonectomy, cytoreduction has not shown promising results on its own, but can improve life expectancy when combined with chemotherapy. In one study, this technique extended life span and allowed patients to live for two to three more years.

Paracentesis

Unlike peritonectomy and cytoreduction, paracentesis is a strictly palliative procedure meant to relieve symptoms. It is a fast procedure that does not require admittance to a hospital.With the guidance of an ultrasound machine, a surgeon inserts a fine needle into the abdominal cavity in order to drain built-up fluid. This relieves pressure, which can reduce abdominal pain and help patients breathe more easily.

Chemotherapy

Chemotherapy is another frequent treatment for peritoneal mesothelioma patients. Chemotherapy drugs are used to shrink the mesothelioma tumor and slow down further growth. The most common chemotherapy regimens for peritoneal mesothelioma involve a combination of drugs. Commonly used pairs are pemetrexed with cisplatin or carboplatin, or gemcitabine with cisplatin or carboplatin.

Because of the aggressive nature of mesothelioma, chemotherapy is best used in conjunction with surgery. Neoadjuvant chemotherapy is administered before surgery, and hyperthermic intraoperative intraperitoneal chemotherapy is given during or directly after surgery. A post-operative chemotherapy regime may also include systemic chemotherapy.

Neoadjuvant Chemotherapy

Any type of "neoadjuvant" ('neo' indicates 'before' and 'adjuvant' is a word for any therapy administered to improve the effects of another treatment) therapy is given prior to another form of treatment to improve efficacy. Neoadjuvant chemotherapy is used to reduce tumor size and growth prior to surgical procedures for peritoneal mesothelioma. This can make surgery easier (in that tumors are smaller and thus easier to remove) and more effective. This type of treatment generally uses a combination of the chemotherapeutic drugs pemetrexed and cisplatin.

Neoadjuvant chemotherapy typically begins three months prior to the surgery. It is usually administered three days out of every two weeks for the duration of two months. Then, the patient is usually given a month to recover from chemotherapy before surgery is performed.

Heated Chemotherapy

Some patients may be eligible for hyperthermic intraoperative intraperitoneal chemotherapy (HIIC), in which heated chemotherapeutic drugs are administered directly into the abdominal cavity. Also called heated chemotherapy, this type of treatment is usually limited to patients who are in good overall health and whose peritoneal mesothelioma is in its early stages.

For the best results, this procedure is performed at the same time as cytoreductive surgery or shortly after it. The drug is heated to slightly above body temperature and is administered directly into the abdomen via a catheter. This is meant to kill any cancer cells that were left behind during surgery. It also helps reduce the risk of recurrence.

Systemic Chemotherapy

Most chemotherapy treatments also involve systemic chemotherapy. Systemic chemotherapy is the traditional type of chemotherapy, which enters the bloodstream intravenously. It is best for widespread cancers because the medications can reach the entire body. That way, cancer cells can be killed even if they are far from the original tumor site. Doctors typically use the chemotherapy drugs pemetrexed or gemcitabine, in combination with cisplatin or carboplatin for peritoneal mesothelioma patients.

Radiation Therapy

Radiation therapy directs high-energy rays of radiation at tumor areas in order to combat cancer growth. Radiation therapy is not used in most cases of peritoneal mesothelioma because of the nature of the disease. Since peritoneal mesothelioma develops in close proximity to vital abdominal organs, radiotherapy to the area is generally considered too risky to attempt.

Peritoneal Radiation Therapy

However, some studies show that radiation therapy may increase survival rates when used in combination with chemotherapy and surgery. In one study, 27 peritoneal mesothelioma patients underwent this multimodal approach. Patients first underwent surgery followed by a chemotherapy regimen. Then they received whole abdominal radiotherapy, meaning the radiation rays were directed at the abdomen. Patients in the study lived a median of 68 months, nearly five years longer than the average peritoneal mesothelioma patient.

Alternative Therapy

Because of the limitations of conventional treatments for peritoneal mesothelioma, some patients choose to seek out other types of treatment. This may include alternative and complementary therapies such as yoga, massage and acupuncture. Although alternative therapies have not been shown to improve life span, they can be extremely helpful in boosting quality of life by creating a stronger sense of mental and physical wellbeing. Peritoneal mesothelioma patients interested in pursuing alternative treatments should speak with their doctors before beginning any new regimen.

Clinical Trials

Other patients choose to participate in clinical trials in hopes of bettering their prognoses or minimizing symptoms. Enrolling in a clinical trial is a useful way to gain access to the best emerging treatments for peritoneal mesothelioma. Each clinical trial comes with eligibility requirements, and there is no guarantee that the experimental treatment will work. If you'd like to be a part of a clinical trial, let the Mesothelioma Center help. Our experienced Patient Advocates can help you find peritoneal mesothelioma clinical trials in your area. To get started, complete the form on the clinical trial page.

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