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Treatments of Malignant Mesothelioma The treatment of malignant mesothelioma has proven difficult. Because the disease begins in the pleura and peritoneum, which are the membranes surrounding the chest cavity and abdominal cavity respectively, progression of the malignancy results in spread to the underlying organs. The tumor spread makes complete surgical removal nearly impossible. Furthermore, the effectiveness of different treatments has been difficult to evaluate in large treatment trials because there are relatively few cases of malignant mesothelioma. Although the general prognosis for malignant mesothelioma is not encouraging - on average, patients live about one year after diagnosis - an early diagnosis and aggressive treatment can improve survival - up to two years in almost 50 percent of cases and five years (or longer) in 20 percent. Some of the factors that affect prognosis are the type of mesothelioma, the stage of disease at diagnosis, the patient's age and the patient's overall health. The prognosis is best when the mesothelioma is the epithelial type and stage I. Mesothelioma Types of Treatment The primary treatment options for malignant mesothelioma are surgery, radiation therapy and chemotherapy. Mesothelioma Surgery : Before any surgery is considered for the treatment of malignant mesothelioma, the patient's overall health is carefully evaluated. Tests are performed to make sure the patient has no metastatic disease (cancer spread to distant sites) and to evaluate the patient's lung and heart function. Lung function often is compromised in patients with pleural mesothelioma for several reasons. The pleural effusion (fluid collection) and the tumor mass caused by mesothelioma can compress the lung. Also, the patient's exposure to asbestos may have decreased lung function, which also decreases with age. In addition, some patients have a history of smoking cigarettes, which further decreases lung function.Surgery for malignant mesothelioma can be aimed at long-term control (aggressive surgery) or relief of symptoms (palliative procedures). Aggressive Surgery : Extrapleural pneumonectomy involves removal of the pleura, the lung, the diaphragm and the pericardium. The intent of this very aggressive, complicated surgery is to remove as much of the tumor as possible. Not all centers will perform this procedure because of its complexity and because it carries a high risk of death within 30 days after surgery. Extrapleural pneumonectomy typically is performed only in younger patients in good overall health with stage I disease. Patients are evaluated carefully to determine their ability to tolerate the surgery. Mesothelioma Palliative Procedures : When malignant mesothelioma is advanced, palliative procedures can be performed to relieve and/or control symptoms such as breathlessness, which are caused by effusion (fluid collection) or by the tumor compressing the lung or other organs. These procedures do not aim to cure the disease. Thoracentesis can be used to treat effusion in pleural mesothelioma. A needle is inserted into the chest to drain the fluid, relieving breathlessness and pain. Talc may be introduced into the pleura to limit recurrence of the effusion. Similar procedures are used to treat ascites (fluid collection) in peritoneal mesothelioma. Pleurectomy/decortication is the surgical removal of the pleura. This procedure can be performed to reduce pain caused by the tumor mass or to prevent the recurrence of pleural effusion. For peritoneal mesothelioma, surgery generally is aimed at relieving symptoms, such as recurrent ascites or bowel obstruction. As with pleural mesothelioma, complete surgical removal of the entire tumor is unlikely. Mesothelioma Radiation Therapy Because of the location of malignant mesothelioma, it is extremely difficult to deliver high enough doses of radiation to kill the tumor without damaging the surrounding organs. Lower doses of radiation can result in some reduction in the disease, but it is unclear whether this reduction actually results in longer survival than does no treatment. Using radiation therapy after surgery has not been shown to improve survival. However, because surgery is very unlikely to remove the entire tumor, radiation commonly is administered after surgery in the hopes of killing remaining tumor cells. In addition, radiation therapy can be used to relieve symptoms of mesothelioma, including chest pain. Mesothelioma Chemotherapy Chemotherapy - the use of medications to treat cancer - has had disappointing results in the treatment of malignant mesothelioma. Some chemotherapy drugs have a partial effect in some patients. Combination chemotherapy (using more than one drug at the same time) may be given in an attempt to improve response. Some combinations have shown some promise, and some new medications are being tried.Like radiation therapy, chemotherapy may be administered after surgery in an attempt to kill cancer cells that could not be removed during the procedure. Mesothelioma Treatment by Stage Pleural mesothelioma can be treated according to stage; there are no standard treatment options by stage for peritoneal mesothelioma. Stage I (localized) mesothelioma - If a patient wants aggressive treatment and is deemed fit to undergo surgery, some centers may perform an extrapleural pneumonectomy. Another surgical option is pleurectomy/decortication, which is sometimes performed to alleviate some of the symptoms of mesothelioma. Both of these procedures may be followed by radiation therapy or chemotherapy. Stages II, III and IV (advanced) mesothelioma - Pleurectomy/decortication may be performed to relieve symptoms in pleural mesothelioma. Other procedures such as thoracentesis may be performed to drain pleural effusions and prevent them from recurring. Radiation therapy and/or chemotherapy also may be administered for symptom relief. Recurrent malignant mesothelioma - There is no standard treatment for recurrent mesothelioma. Generally, treatments are considered that were not used in the first treatment attempt. Clinical Trials and Future Treatments New treatments for malignant mesothelioma (and possible preventive measures, such as a vaccine) are being evaluated in clinical trials, and the future holds some promise. Clinical trials are research studies that evaluate new treatments for safety and effectiveness. There are no guarantees that a new treatment will work, and there are some risks. However, a clinical trial is not undertaken unless the researchers believe the treatment may have some value. Here are some of the treatments for malignant mesothelioma that are being evaluated: Combination chemotherapy - Different combinations of chemotherapy drugs have been tried with mixed results. A recent study showed some benefit of combining cisplatin (Platinol) and gemcitabine (Gemzar). The researchers used the combination to treat 21 patients with advanced mesothelioma, of whom 47 percent showed a partial response. Intracavitary chemotherapy - Instilling chemotherapy drugs directly into the pleural or peritoneal space is being researched because of its advantage over traditional chemotherapy. Because the drug is instilled directly into the cavity, much greater doses can be given to patients without causing severe side effects. Some studies have shown this therapy to result in control of effusions and reduced tumor size. Brachytherapy (intracavitary radiation therapy) - In this treatment, a radioactive substance is placed directly into the pleural or peritoneal space. Multimodality therapy - Any combination of surgery, radiation therapy and chemotherapy is multimodality therapy. For example, researchers have combined surgery with intracavitary radiation or chemotherapy and then administered radiation or chemotherapy afterward. Gene therapy - In this approach, a virus that has been genetically altered is introduced into the tumor. The virus infects the tumor cells and makes them vulnerable to anticancer drugs. Immunotherapy - Treatments that stimulate the body's immune system to fight cancer cells are called immunotherapy. Photodynamic therapy - In this treatment, drugs that are sensitive to light are taken up by the tumor cells, which are then exposed to light.