Mesothelioma Treatment Options

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Pleural Treatment: Extrapleural Pneumonectomy

Extrapleural Pneumonectomy

Developed by Dr. David Sugarbaker for early stage pleural mesothelioma.

Extrapleural pneumonectomy is a treatment for early stage mesothelioma. This procedure often includes pre-operative chemotherapy followed by an extensive surgery to remove the diseased lung. Intraoperative chemotherapy may be applied remove any remaining cells. The developer of this surgery, Dr. David Sugarbaker, has been practicing medicine for over thirty years.

Treatment Procedure:

• 1

  

  Pre-Operative

  Neoadjuvant Chemotherapy

• 2

  

  Operation

  Extrapleural Pneumonectomy & Chemotherapy

• 3

  

  Post-Operative

  Adjuvant Chemotherapy & IMRT Radiation Therapy

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Preoperative Treatment

• Cisplatin and pemetrexed is the most common and effective combination for patients prior to the EPP surgery.
• 61.2 percent of patients who received this combination lived at least two years past their initial surgery.

Extrapleural Pneumonectomy

The extrapleural pneumonectomy is used to treat patients with stage 1 or 2 pleural mesothelioma. The affected lung is removed along with the entire pleura (lining), part of the pericardium and part of the diaphragm. By removing the lung and the tissue around it, metastasis of pleural mesothelioma is limited.

Intrapleural Chemotherapy

Sometimes hyperthermic intraoperative cisplatin chemotherapy (HIOC) is used immediately following an extrapleural pneumonectomy. During this process, chemotherapy is heated to about 107 degrees. The heated chemo wash is then placed inside the chest cavity and is washed around for about 1 hour. The goal of this procedure is to help remove any mesothelioma cells that may have been left behind by surgery.

In a study conducted by Dr. David Sugarbaker, epithelial malignant pleural mesothelioma patients that experienced HIOC had a longer survival rate. It also took their disease longer to recur.

Postoperative Treatment

• Chemotherapy is used in all patients. Medication may be changed if patients don’t respond positively.
• Intensity modulated radiation therapy (IMRT) may be administered directly to the chest cavity to destroy remaining cancer cells.
• Dr. Anne Tsao concluded that only 13 percent of patients who received multimodal treatment showed local recurrence of mesothelioma after an EPP surgery.
• Distant recurrence is more common, occurring in half of all patients.

Pleural Treatment: Pleurectomy / Decortication

Pleurectomy with Decortication

Developed by Dr. Robert Cameron for early stage pleural mesothelioma.

As the only lung-sparing surgery for pleural mesothelioma, the pleurectomy with decortication has become a highly popular treatment option. The most successful treatment is the pleurectomy with decortication. In a pleurectomy, surgeons remove the diseased lining of the lungs. Some patients may be treated with intraoperative radiation therapy. The procedure often includes pre-operative chemotherapy followed by surgery and postoperative chemotherapy. Dr. Robert Cameron turned the pleurectomy into the successful treatment it is today. He is the director of the mesothelioma program at UCLA Cancer Center.

Treatment Procedure:

• 1

  

  Pre-Operative

  Neoadjuvant Chemotherapy

• 2

  

  Operation

  Pleurectomy & Chemotherapy

• 3

  

  Post-Operative

  Adjuvant Chemotherapy

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Preoperative Treatment

• Most patients receive 4 weeks of chemotherapy drug to stop the growth of future tumors.
• Chemotherapy used prior to surgery helps shrink the tumors, making it easier for the surgeon to remove more of the diseased tissue.

Pleurectomy/Decortication (P/D)

The pleurectomy/decortication involves removing the pleura (lining of the lungs)affected with mesothelioma tumors in patients with stages 1 or 2 mesothelioma. This surgery is a lung-sparing surgery and has a lower mortality rate than an extrapleural pneumonectomy.

Postoperative Treatment

• Adjuvant chemotherapy helps kill cancerous cells left behind from surgery.
• Patients typically remain on cisplatin for 3 to 5 weeks after surgery.
• Adjuvant radiation may also be used.

Peritoneal Treatment: Cytoreduction with HIPEC

Cytoreduction with HIPEC

Developed by Dr. Paul Sugarbaker for early stage peritoneal mesothelioma.

Dr. Paul Sugarbaker created a method of treating peritoneal mesothelioma known as "The Sugarbaker Procedure.” The Sugarbaker Technique is a cytoreductive surgery to remove tumors from the abdomen followed by heated intraoperative chemotherapy (HIPEC). This surgery is used in patients with abdominal cancers like peritoneal mesothelioma. Dr. Sugarbaker (brother of pleural mesothelioma specialist, David) is the director of surgical oncology at the Washington Cancer Institute in Washington D.C.

Treatment Procedure:

• 1

  

  Pre-Operative

  Neoadjuvant Chemotherapy

• 2

  

  Operation

  Cytoreduction & HIPEC Chemotherapy

• 3

  

  Post-Operative

  Radiation Therapy & Adjuvant Chemotherapy

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Pre-Operative Treatment

• Neoadjuvant chemotherapy is usually given to patients before they undergo a cytoreductive surgery.
• Cisplatin and pemetrexed is a common combination given to patients.
• 30 percent of patients who received neoadjuvant chemotherapy before cytoreduction showed increased lifespan after their surgery.

Cytoreduction

Patients with early stages of peritoneal mesothelioma are eligible for a cytoreduction. This surgery removes the peritoneum and any tumors within it. On average, this surgery can increase patient life expectancy from about 11 months without surgery to 87.2 months when used with HIPEC.

Heated Intraperitoneal Chemotherapy (HIPEC)

HIPEC is used in conjunction with cytoreduction surgery. The patient’s abdominal cavity is filled with a chemotherapy drug, and the organs and tissue are bathed in the substance. After 60 to 90 minutes, the chemotherapy is rinsed and the patient is sewn up. This chemotherapy kills any remaining cancer cells left over after the cytoreduction surgery.

Post-Operative Treatment

• Radiation and chemotherapy are both used after a cytoreduction surgery.
• Dr. Paul Sugarbaker has used a combination of Taxol (medication which inhibits cancer growth) and fluorouracil (stops growth of certain proteins) in the early post-operation period.
• Afterwards, patients may be treated with cisplatin and doxorubicin or cisplatin and mitomycin C.

Clinical Trials

There are many groundbreaking clinical trials currently working towards a cure. These clinical trials are usually provided at no cost to the patient. Some research groups even compensate patients for time and travel.

Clinical trails are performed to develop new treatments and to test effectiveness and safety. Through these trials, researchers also learn any reactions or side effects patients may experience.

Every modern mesothelioma treatment began as a clinical trial, and many lives were saved as a result of these treatments. Patients who take part in clinical trials have been shown to have significantly better chances of survival that those who do not.

Emerging Treatments

There are also experimental therapies currently being researched and tested. Gene therapy is a new treatment option that uses healthy DNA to repair the cancerous cells into healthy cells.

Immunotherapy is another novel treatment that is shaking things up in the mesothelioma community as well. These treatments use various methods to stimulate the immune system to attack mesothelioma cells. Immunotherapy provides a welcome alternative to standard chemotherapy for which some patients do not respond.

Another emerging treatment is photodynamic therapy. This treatment option aims at killing cancer cells by exposing them to oxygen that is activated by a light source. Photodynamic therapy has been used in conjunction with pleurectomies. By using photodynamic therapy, the remaining cancer cells are killed after the pleura is removed.

Emerging treatments such as photodynamic therapy may become the standard of care for mesothelioma in the future. It is also important to remember that all methods of treatment started out in trials. The advantage of clinical trials for mesothelioma patients is that most of the therapies being tested provide a treatment option where there is no standard of care, such as late stage mesothelioma. Get enrolled in a clinical trial to become one of the patients utilizing new, cutting-edge treatments.

Connect with a Mesothelioma Specialist

Connecting with a specialist who is knowledgeable about mesothelioma is critical. Mesothelioma is a rare cancer and there are a limited number of specialists who are qualified to treat patients with it.

Specialists can also offer more aggressive treatments options than a general oncologist. These treatments have the potential to increase life expectancy significantly, and new treatments are always emerging.

The doctors above are just a few of the specialists we can connect you with.

Our Doctor Match program involves our team traveling across the nation, developing relationships with the best mesothelioma specialists and cancer centers. Through these relationships, we connect patients with a specialist uniquely capable of treating a patient, based on their diagnosis.

Find out more about specialists around the United States with our free Doctor Match program.

Veteran-Specific Treatment

Over one-third of all patients diagnosed with mesothelioma are military veterans. There are mesothelioma VA treatment centers and veteran benefits that can reduce the cost of treatment.

The VA has two of the most renowned mesothelioma treatment centers in the country at the West Los Angeles VA and the Boston VA. These centers accept veterans from across the country and the VA offers travel assistance in some cases.

It is important for veterans to realize that a general oncologist is not a substitute for a mesothelioma specialist. General oncologists are unlikely to have experience treating the disease and may not recommend the best treatment.

Learn more about the VA treatment centers that specialize in treating veterans with mesothelioma:

• West Los Angeles VA — The West Los Angeles VA is home to the Elmo Zumwalt Comprehensive Mesothelioma Center. The program is led by Dr. Robert Cameron, the innovator of the pleurectomy/decortication. He accepts patients from across the country who are looking for a specialist.
• Boston VA — On the eastern side of the country, the Boston VA has developed a treatment program for mesothelioma patients by collaborating with nearby Brigham and Women’s Hospital (BWH). The Boston VA’s mesothelioma program is overseen by specialist Dr. Avi Lebenthal, who also treats patients at BWH.