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Treatment

By Harvey I. Pass, M.D.

Novel mesothelioma treatments involving surgery, chemotherapy, radiation therapy, and new molecular therapies are becoming available through the NYU Thoracic Oncology Program and other cancer centers with mesothelioma programs and experts. We encourage you and your family to compare medical opinions, learn the newest diagnostic and treatment options and make an informed decision about your care.

Treatment depends on a number of factors, including the extent of your disease at diagnosis and your overall health. Aggressive therapies can involve a combination of surgery with chemotherapy and radiation therapy. Non-surgical options include chemotherapy, as well as new clinical trials for the disease.

Surgery

Surgical options for mesothelioma range from gentle procedures to alleviate fluid build-up to a radical approach for the most advanced stages of the disease. Options include:

  • PleurX Catheter: A new device that is placed directly in the chest. The PleurX catheter uses a one-way valve to drain fluid from the chest cavity. Allows for drainage at home with instructional kits provided by the company. Generally used when major surgery cannot be tolerated.

  • Thoracoscopy: A lighted tube that is inserted into the chest to remove fluid from the cavity and replace it with a material (either talc or chemotherapy) that adheres the lung to the chest wall, eliminating the space for fluid to accumulate. Generally used when major surgery cannot be tolerated.

  • Pleurectomy: A surgical procedure that removes the pleura and releases lung that is trapped by the mesothelioma. The goal is to reduce the thickness of the tumor to minimal levels (cytoreduction). Only 20 to 30% of patients qualify for this operation, since it may only be useful for patients with early onset mesothelioma.

  • Extrapleural Pneumonectomy (EPP): A more extreme surgical procedure for the cytoreduction mesothelioma involving the removal of the pleura, lung, part of the heart sac (pericardium) and muscle of breathing (diaphragm). Large amounts of mesothelioma require this procedure. Risk of death is 5% when performed by experts. Patients must receive chemotherapy at some point before, during, or after EPP, as the disease can return in sites away from the chest, including the stomach.

Chemotherapy

Dramatic improvements have been made in chemotherapy options for mesothelioma.

Standard treatment uses a combination of pemetrexed (Alimta) and cisplatinum to shrink the tumor, with a success rate of 41%. Other drugs can be prescribed if the disease returns and there are new drug trials underway which explore targeting certain genes in mesothelioma.

Radiation Therapy

Mesothelioma will return, even after EPP.

Radiation therapy is usually given after surgery as it has been shown to decrease the chance for the disease to reoccur.