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Treatment by stage



Each of four stages of mesothelioma has their own treatment.

Stage 1. Mesothelioma: The most common method of treatment for patients in stage 1 is surgical removal either using pleurectomy/decortication or alternatively extrapleural pneumonectomy. It is currently unknown whether chemotherapy or radiation therapy for stage 1 mesothelioma has any value for the patient.

Stages 2 and 3 Mesothelioma: Unfortunately, there is no known cure once the mesothelioma has advanced to these stages. Patients should consider enrolling in clinical trials which aim to test and evaluate new treatments. In the meantime, patients could receive palliative care to relieve symptoms. For example thoracentesis can remove accumulated fluid in the chest cavity, operations can be useful in removing parts of the tumor and radiation therapy/chemotherapy can sometimes be useful in easing symptoms.

Stages 4 and 5: Unfortunately there is no known cure once the cancer has reached this stage due to the fact that the cancer has spread to different organs. Patients should once again consider enrollment in clinical trials which aim to test and evaluate new treatments. If radiation or chemotherapy is used it should be clear that the purpose is to relieve symptoms rather than cure the whole thing. At this stage, supportive care, such as a good hospice program, and pain management should be the prioritized elements of patient care. Patients should be aware that pain medications for mesothelioma are available to ease symptoms and should not hesitate to discuss or request this option with their doctors.

If to divide mesothelioma stages into localized and advanced there are the following treatments:

Localized Malignant Mesothelioma (Stage I)

  • Standard treatment options:
    • Solitary mesotheliomas:
      • Surgical resection en bloc including contiguous structures to ensure wide disease-free margins. Sessile polypoid lesions should be treated with surgical resection to ensure maximal potential for cure.
    • Intracavitary mesothelioma:
      • Palliative surgery (i.e., pleurectomy and decortication) with or without postoperative radiation therapy.
      • Extrapleural pneumonectomy.
      • Palliative radiation therapy.
  • Treatment options under clinical evaluation:
    • Intracavitary chemotherapy following resection.
    • Multimodality therapy.
    • Other clinical trials.

Advanced Malignant Mesothelioma (Stages 2, 3, and 4) (regular treatment options).

-Treatment to ease symptoms including drainage of bodily fluids, thoracoscopic pleurodesis or chest tube pleurodesis

-palliative surgery in selected patients

-single-agent chemotherapy. Some success has been reported with use of doxorubicin, epirubicin, mitomycin, cyclophosphamide, cisplatin, carboplatin, and ifosfamide.

- Combination chemotherapy (currently under clinical evaluation). Information regarding ongoing clinical trials is available from the NCI web site.

- Mutimodality clinical trials.

-Intracavitary Therapy. The administration of Intrapleural and intraperitoneal chemotheraputic agents such as cisplatin, mitomycin, and cytarabine, have been reported to produce temporary reduction in size of tumor masses as well as temporary control of body fluids in small clinical studies. A Greater amount of studies are needed to determine the effectiveness of intacavitary therapy.

- All mesothelioma, with the exception of localized mesothelioma, is generally not treatable. Although some patients have accomplished short term survival with aggressive methods, it is unclear if their survival can be attributed to different therapeutic agents or by combinations of different therapeutic agents.

- Although more research must be conducted, initial studies show that extrapleural pneumonetomy in selected patients in early stages of the disease, may improve the overall chances of patient survival with that cancer never returning.

- Radiation therapy or Chemotherapy following surgical procedures has not been proved to increase the overall chances of survival, however, the use of radiation therapy in pleural mesohelioma has been shown to have the effect of temporarily relieving pain in the majority of patients treated.

Both single and combined modality studies have evaluated the chemotherapy using single-agent as well as combination. Doxorubicin, the most studied drug has shown the approximate response rate from 15% to 20% among the studied patients. During small phase II trials the combination chemotherapy regimens giving higher response rate has been discovered, though having shown high toxic rate as well. There is still no proof that this combination succeeds either in prolonging the survival or in controlling the symptoms. Pleural sclerosing procedures produce the treatment for recurrent pleural effusions. Despite the secondary failure rates to the tumor's bulk precluding the adhesion of the pleura because the lung is unable to expand entirely.

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