Treatment For Mesothelioma ?

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Treatment For Mesothelioma ?

Treatment For Mesothelioma :

  • Surgery
  • Chemotherapy
  • Immunotherapy
  • Radiation
  • Multimodal

Surgery


Patients diagnosed in the early stages benefit most from surgery. It offers them the best chance at living longer lives. These procedures remove tumors from the chest area and improve quality of life.

Extrapleural Pneumonectomy (EPP)
Extrapleural Pneumonectomy (EPP): EPP removes the cancerous lung and all nearby areas where mesothelioma spreads. This can include nearby lymph nodes, parts of the chest lining, heart lining and diaphragm.

Pleurectomy and Decortication (P/D)
Pleurectomy Decortication (P/D): P/D spares the lung and only removes cancerous parts of the pleural lining, the chest wall lining and the diaphragm. This is a less aggressive surgery.

Patients with early-stage peritoneal mesotheliomas might also benefit from surgery to take out as much of the cancer as possible. This may be combined with heated intraperitoneal chemotherapy (HIPEC). Some patients have long remissions after this treatment. (This means the cancer is under control and not growing or spreading.)

Surgery may also be helpful for some later-stage cancers, but the benefits are more likely to last only a short time.

Sometimes, the surgeon may think the cancer is resectable based on imaging tests (like CT scans) done before surgery, but once the operation starts it becomes clear that not all of the cancer can be removed. In these cases the surgeon may switch to a less extensive operation like P/D (which is easier to tolerate) or even stop the surgery altogether if it’s not likely to be helpful. Treatment would then be the same as for unresectable mesotheliomas (see below).

Doctors are still studying whether giving chemotherapy (chemo) before surgery (called neoadjuvant therapy) or giving chemo and/or radiation therapy after surgery (adjuvant therapy) is helpful. Not all doctors agree on the best ways to use these treatments together. Some doctors prefer to give chemo, either before or after surgery. Radiation therapy might be used after surgery, either alone or along with chemo.

If you’re not healthy enough to have a major operation, your treatment will be the same as for unresectable mesothelioma (discussed below).

If you have symptoms because of fluid buildup in the chest or abdomen (belly), other approaches such as thoracentesis/paracentesis or pleurodesis may be helpful. (These are described in palliative procedures.)

Because these cancers can be hard to treat, taking part in a clinical trial of a new, and maybe better, treatment may be another option. These types of studies are usually done in large medical centers.

Chemotherapy

Doctors may recommend chemotherapy to patients who are not eligible for surgery. This mesothelioma treatment also helps extend survival rates. A 2016 Wayne State University study found patients given a combination of chemo drugs lived three times longer than patients without it.

Hyperthermic intrathoracic chemotherapy (HITHOC): An experimental procedure that delivers heated chemotherapy drugs throughout the chest cavity.

Radiation

Radiation therapy controls symptoms when surgery is not an option. It eases symptoms such as chest pain and discomfort. And it can also reduce the risk of local recurrence when combined with surgery.

External Beam Radiation Therapy: Machine placed outside the body delivers X-ray beams to kill cancer cells
Brachytherapy: Uses a radioactive implant to kill nearby cancer cells
Hyperthermic intrathoracic chemotherapy may help pleural mesothelioma patients, too. It delivers a heated chemo drug treatment to the chest cavity after surgery.

Immunotherapy


Immunotherapy has been shown to be successful in treating mesothelioma and other diseases by boosting the immune system. Used on its own or when combined with standard treatments like chemotherapy, immunotherapy has shown promising success in the treatment of mesothelioma, in some cases extending life expectancy by months or even years.

The effectiveness of different immunotherapy drugs continues to be tested, particularly when used during a multimodal treatment plan. Types of immunotherapy that have been used include:

Adoptive cell therapy
Cancer vaccines
Checkpoint inhibitors
Monoclonal antibodies

Multimodal

A multimodal treatment approach usually centers on a major tumor-removing surgery with chemotherapy and radiation therapy administered before, after or during the surgery.

For peritoneal mesothelioma, cytoreductive abdominal surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is the most effective treatment approach.
For pleural mesothelioma, there is no single treatment plan that is clearly better than all the others. It depends on the patient’s specific circumstances and the judgement of their doctors.

Gene Therapy

Gene therapy is another emerging treatment that has shown promise in treating malignant mesothelioma for some patients. Gene therapy works by repairing the genetic structure or function of cells. If repair is successful, it can potentially treat the disease or help prevent the development of diseases without as many side effects as treatments like chemotherapy or radiation therapy. Types of gene therapy include:

Gene transfer
Genetic virotherapy
Oncolytic viruses

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