Pleural Mesothelioma Treatment
Pleural mesothelioma is a rare cancer that originates in the lining of the lungs, with about 1,500 to 2,000 cases diagnosed in the United States each year. No cure has been discovered for pleural mesothelioma, but there are treatments to manage symptoms and extend life expectancy. Most patients live four to 18 months after diagnosis, but some patients may live five years or longer.
Pleural mesothelioma is a rare cancer that originates in the lining of the lungs, with about 1,500 to 2,000 cases diagnosed in the United States each year. No cure has been discovered for pleural mesothelioma, but there are treatments to manage symptoms and extend life expectancy. Most patients live four to 18 months after diagnosis, but some patients may live five years or longer.
Speaking with a pleural mesothelioma specialist can help patients understand which treatment options may be the best for their unique diagnosis. The Mesothelioma Center's free Doctor Match Program can pair you with the nation's top pleural mesothelioma doctors and help you find treatment facilities near you. Visit this page or call (800) 549-0544 to learn more about the program.
Treatment Options Vary
Treatment for malignant pleural mesothelioma (MPM) may be palliative (which aims to relieve symptoms) or potentially curative (which attempts to cure the disease or extend life expectancy). For most patients, surgery is performed to remove as much tumor growth as possible. After that, doctors recommend chemotherapy and/or radiation therapy to help kill as remaining cancer cells as possible. Some doctors may also suggest up-and-coming treatment options such as immunotherapy, photodynamic therapy and gene therapy. Patients can also consider alternative treatments, which can help alleviate pain and improve quality of life, or clinical trials, which can offer opportunities to use experimental new treatments.
Patients may be eligible for certain treatments based on a number of factors. For example, the most common candidates for potentially curative surgery are patients around 50 years old or younger who are in overall good health and whose pleural mesothelioma has not spread throughout the body. Older or less healthy patients are more susceptible to complications during treatment and longer recuperation times. Additionally, if the cancer is in later stages when the cancer has spread from its origin, treatments such as surgery will not be particularly effective because the growth and spread of pleural mesothelioma makes it nearly impossible to remove all the tumors and cancerous cells.
Surgery
Depending on each patient's unique situation, surgery can be potentially curative or strictly palliative. Patients who qualify for curative surgery usually undergo one of two potentially curative surgeries: extrapleural pneumonectomy or pleurectomy/decortication. These vastly different surgeries have both been shown to add months to life span, but they each come with a set of complications and risks. Other surgical options may include pleurodesis or pleurectomy.
Extrapleural Pneumonectomy
Extrapleural pneumonectomy (EPP) is a very serious, potentially curative procedure that removes the entire cancerous lung. The surgery aims to remove as much cancerous tissue as possible, so it may also include the removal of parts of the chest lining, heart sac lining and diaphragm. Naturally, the loss of a lung significantly impacts quality of life for most patients. It severely and often permanently restricts lung functioning and physical ability.
However, EPP is still favored by some surgeons because it has been found to extend life span and is associated with long-term survival. One 2008 study found that patients with Stage I MPM survived a median of 22 months after undergoing EPP. Stage IV patients, on the other hand, had predictably shorter life spans, surviving a median of four months after surgery. Still, some Stage IV patients in the study survived more than four years after receiving the same treatment.
Pleurectomy/Decortication
Pleurectomy/decortication (P/D) is a lung-sparing alternative to EPP that many surgeons now favor. Like EPP, P/D is a potentially curative procedure. However, P/D leaves the lung intact and removes the cancerous lining of the lung. It usually also removes parts of the chest lining and part of the surface of the lung.
The same 2008 study showed that P/D was a significantly better option than EPP for patients in Stage I. Stage I patients who underwent P/D lived a median of 46 months, just shy of four years. As patients entered later stages, the two procedures had somewhat comparable results. Patients in Stage IV who received the P/D surgery had a median survival of nine months.
Palliative Surgeries
Doctors may consider palliative surgeries if they believe P/D and EPP are too dangerous or will be ineffective. Some of the main palliative procedures are pleurodesis and pleurectomy.
Pleurodesis
- is used to drain built-up fluid in the chest cavity. It is designed to seal pleural spaces and prevent further fluid accumulation. This process relieves pressure, alleviates chest pain and eases breathing.
Pleurectomy
- removes the cancerous lining of the lung. Like pleurodesis, it is helpful for patients with fluid buildup. The procedure can relieve common symptoms such as chest pain and shortness of breath.
Chemotherapy
Chemotherapy uses drugs in order to shrink, stop or slow the growth of cancer cells. Traditionally, chemotherapy drugs have been administered intravenously or orally. Certain drugs have proven more successful in MPM patients, but even the most effective drugs help fewer than half of pleural mesothelioma patients. Chemotherapy drugs can be administered alone (called "single-agent" chemotherapy) or in combination, and combinations are more common when treating pleural mesothelioma patients.
41% patients experience a slowing of tumor growth or shrinkage in tumor size.One of the most common combinations for pleural mesothelioma is cisplatin and pemetrexed, which produced a response rate of 41 percent in a 2003 study. When administered alone, methotrexate has been one of the most successful single chemotherapeutic agents for pleural mesothelioma with a response rate of 41 percent, meaning two of every five patients experience a slowing of tumor growth or shrinkage in tumor size.
In the past few years, intrapleural chemotherapy has shown promising results. Intrapleural chemotherapy delivers chemotherapeutic agents directly into the pleural cavity rather than into the bloodstream intravenously. The drugs are usually heated to slightly above body temperature and administered during or shortly after surgery. Clinical trials have shown that most patients who receive intrapleural chemotherapy add months to their survival, with a median life span of about a year or more.
Learn more about chemotherapy for mesotheliomaRadiation Therapy
A combination of surgery, chemotherapy and/or radiation therapy can significantly increase life expectancy. One study from Brigham and Women's Hospital found that one-third of patients who underwent a trimodal approach — surgery, followed by chemotherapy and then radiation — lived two years or longer, and 15 percent lived five years or longer.
(Source: http://www.moffitt.org/CCJRoot/v13n4/pdf/255.pdf)Radiation therapy applies a form of high-energy radiation, such as X-rays, to the cancerous area of the body. This is meant to kill cancer cells in the area. In pleural mesothelioma, radiation therapy is not often used as a potentially curative measure. Because pleural mesothelioma develops in close proximity to vital organs such as the heart, radiation therapy may be considered too dangerous for patients in poor health.
But for patients who do qualify, radiation therapy can have a significant effect on survival times, especially when used after surgery. One study found that patients who underwent P/D followed by radiation therapy had a median survival of 21 months. A similar study found that EPP followed by chemotherapy and then by radiation therapy led to a median survival of 19 months.
If a patient is a good candidate for radiation therapy, a doctor may recommend brachytherapy or intensity-modulated radiation therapy. These two specific types of radiation therapy have shown good results in pleural mesothelioma patients.
Learn more about radiation therapy for mesotheliomaNovel Treatments
As more studies are completed, new treatment options continue to emerge for pleural mesothelioma patients. Among those, top new treatment options include immunotherapy, photodynamic therapy and gene therapy. These techniques may be potentially curative and can help extend life expectancy. But since they are such new treatment options, the efficacy of each type is still being tested.
Immunotherapy
Immunotherapy is a type of treatment which uses the body's immune system to fight the cancer. Currently, it uses laboratory-created chemicals which act like certain chemicals naturally made by the body. These are used to enhance immune system response, which can include helping the body to identify pleural mesothelioma cells as well as to fight and kill them. This method is promising, as numerous studies have shown its positive effects on life span. In one study, MPM patients had a median survival of 15.6 months after receiving immunotherapy.
Photodynamic Therapy
During photodynamic therapy, a doctor injects a drug called a sensitizer. This drug, often the sensitizer known as Photofrin II, is absorbed by MPM cells but does not generally affect healthy cells. The drug takes a few days to be entirely absorbed. Then, light is used to activate the drug, a process which kills the cancer cells. In preliminary testing, this procedure's success has been questionable. When used alongside surgery and chemotherapy, pleural mesothelioma patients lived a median of about 14 months.
Gene Therapy
Gene therapy generally involves altering a virus to carry normal genetic material to cancerous cells with the goal of changing the genetic makeup of the cancerous cells to that of normal cells. The patient is given the virus, which then spreads through the body. It carries the genetic material to cancer cells, forcing the pleural mesothelioma cells to act like healthy cells and produce normal proteins. As of now, the effectiveness of gene therapy is not entirely determined. Clinical trials continue to study the utility of this new treatment in pleural mesothelioma patients.
Lifestyle Changes and Complementary Therapy
Patients struggling with symptoms of pleural mesothelioma may want to consider incorporating alternative and complementary therapies such as respiratory therapy, which can help with chest pain, difficulty breathing, fatigue and other common symptoms. Patients should also consider making lifestyle changes such as eating and avoiding certain foods. For example, slippery elm bark has been known to help with respiratory problems and is often recommended for pleural mesothelioma patients.
Although these techniques are not known to increase life expectancy, they can significantly boost quality of life. Speak with your doctor about the benefits of incorporating one or a few of the following therapies:
- Respiratory therapy
- Nutritional changes
- Massage
- Acupuncture
- Yoga
- Meditation
Clinical Trials
Patients should look into clinical trials near them and consider participating. Pleural mesothelioma clinical trials often grant patients access to top new treatments such as immunotherapy, photodynamic therapy and gene therapy. To find a clinical trial that's right for your diagnosis, contact the Mesothelioma Center. Complete the form on this page to get help enrolling in a clinical trial.
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Last Modified Thursday, May 17th, 2012 | Disclaimer | Privacy Policy |
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