Malignant Mesothelioma : Treatment Options

by National Cancer Institute

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There are different types of treatment for patients with malignant mesothelioma.

Different types of treatments are available for patients with malignant mesothelioma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Three types of standard treatment are used:

Surgery

The following surgical treatments may be used for malignant mesothelioma:

Wide local excision: Surgery to remove the cancer and some of the healthy tissue around it.

Pleurectomy and decortication: Surgery to remove part of the covering of the lungs and lining of the chest and part of the outside surface of the lungs.

Extrapleural pneumonectomy: Surgery to remove one whole lung and part of the lining of the chest, the diaphragm, and the lining of the sac around the heart.

Pleurodesis: A surgical procedure that uses chemicals or drugs to make a scar in the space between the layers of the pleura. Fluid is first drained from the space using a catheter or chest tube and the chemical or drug is put into the space. The scarring stops the build-up of fluid in the pleural cavity.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after surgery, to increase the chances of a cure, is called adjuvant therapy.

Radiation therapy

Chemotherapy

New types of treatment that are being tested in clinical trials include the following:

Biologic therapy

Treatment Options for Malignant Mesothelioma

Localized Malignant Mesothelioma (Stage I)

If the malignant mesothelioma is in one part of the chest lining, treatment will probably be surgery to remove the part of the chest lining with cancer and some of the tissue around it.

If localized malignant mesothelioma is found in more than one place in the chest, treatment may be one of the following:

• Pleurectomy and decortication, with or without radiation therapy, as palliative therapy to relieve symptoms and improve the quality of life.
• Extrapleural pneumonectomy.
• Radiation therapy as palliative therapy to relieve symptoms and improve the quality of life.
• A clinical trial of anticancer drugs placed directly into the chest after surgery to remove the tumor.
• A clinical trial of combinations of surgery, radiation therapy, and chemotherapy.
• A clinical trial of a new treatment.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Advanced Malignant Mesothelioma (Stage II, Stage III, and Stage IV)

Treatment of advanced malignant mesothelioma may include the following:

• Surgery to drain fluid that has collected in the chest, to reduce discomfort. Pleurodesis may be done to stop more fluid from collecting in the chest.
• Pleurectomy and decortication, as palliative therapy to relieve symptoms and improve the quality of life.
• Radiation therapy as palliative therapy to relieve pain.
• Chemotherapy with one anticancer drug.
• A clinical trial of combination chemotherapy.
• A clinical trial of combinations of surgery, radiation therapy, and chemotherapy.
• A clinical trial of chemotherapy placed directly into the chest cavity or abdominal cavity to shrink the tumors and keep fluid from building up.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Recurrent Malignant Mesothelioma

Treatment of recurrent malignant mesothelioma may include the following:

• A clinical trial of biologic therapy.
• A clinical trial of chemotherapy.
• A clinical trial of surgery.

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