Mesothelioma Multimodal Therapy

Mesothelioma multimodal treatment involves the combination of several different treatment methods. Combining multiple treatment procedures may give the best chance for increased life expectancy to mesothelioma patients.

Mesothelioma is a very rare, highly aggressive cancer that when left untreated, has a very poor prognosis. Combining multiple treatment options into “multimodal therapy” can give the patient the best chance for increased life expectancy and may increase patient quality of life. Though each patient is different, some patients who receive multimodal therapy treatments have lived for many months or years longer than expected.

Multimodal Treatment Options

Multimodal therapy simply means that more than one treatment type is used at the same time or alongside one another. The components of multimodal treatment regimens may include:

Surgery
Chemotherapy
Radiation Treatment
New Technologies

Surgery as Part of Multimodal Mesothelioma Treatment

Surgery is a commonly used method to treat mesothelioma patients. In some cases, surgery is performed as a curative treatment to increase life expectancy. In other cases, surgery may be a palliative treatment method intended to reduce symptoms and improved quality of life.

Surgeries commonly performed as part of curative multimodal therapy for mesothelioma treatment include:

Pleurectomy / Decortication (P/D) – performed on pleural mesothelioma patients and involves the surgical removal of the entire pleural lining which may begin to constrict lung expansion. It is performed to remove the mesothelial layer that has become cancerous, along with the healthy tissue surrounding it. It may decrease compression on the affected lung and reduce symptoms.
Extrapleural Pneumonectomy (EPP) – performed on pleural mesothelioma patients and involves the surgical removal of the entire lung and surrounding tissue on the affected side. It is a highly invasive surgery that has traditionally been quite risky but recent evidence suggests it is highly effective as part of a multimodal treatment plan.
Cytoreduction – performed on peritoneal mesothelioma patients and involves surgical removal of the lining of the peritoneum or abdominal cavity. It is performed to remove the mesothelial layer that has become cancerous, along with healthy tissue surrounding it. It may decrease compression on internal organs and reduce symptoms.
Pericardectomy – performed on pericardial mesothelioma patients and involves the surgical removal pericardial sac surrounding the heart. It is performed to remove the mesothelial layer that has become cancerous, along with the healthy tissue surrounding it. It may decrease compression on the heart and reduce symptoms.

Palliative surgeries performed as a part of multimodal treatment may include:

Thoracentesis – used to drain fluid buildup in the space surrounding the lungs through a needle. It may relieve pressure on the lungs and make breathing easier.
Paracentesis – used to drain fluid buildup in the abdominal cavity (ascites) through a needle. It may relieve pressure on the intestines and diaphragm and increase patient comfort.
Pericardiocentesis – used to drain fluid buildup in the pericardial sac through a needle. It may relieve pressure on the heart, making the heart work more efficiently, relieving symptoms and increasing patient comfort.
Pleurodesis –a procedure used to “fuse” tissues together, eliminating the pleural space surrounding the lungs. It is performed with the injection of an irritating medication and will eliminate the potential for future pleural fluid buildup.

Chemotherapy as Part of Multimodal Mesothelioma Treatment

Chemotherapy is often given alongside other treatments such as surgery for both curative and palliative reasons. Chemotherapy options may include:

Neoadjuvant therapy – chemotherapy given prior to surgery to reduce tumor size and make surgical removal of the tumor(s) easier and more effective.
Adjuvant therapy – chemotherapy given after surgery to ensure that all remaining cancer cells are killed and are not left behind to begin new tumors.
Intraoperative therapy – chemotherapeutic medications can be applied directly to tumors at higher concentrations during surgery. The most common example of this is the heated intraoperative peritoneal chemotherapy (HIPEC) which uses warmed chemotherapeutic medication to “wash” out the abdomen during cytoreduction surgery for peritoneal mesothelioma patients.

A number of chemotherapeutic medications are used for mesothelioma. They may be used as single medications or in combinations of two or more, alongside other treatments for multimodal therapy.

Radiation Therapy as Part of Multimodal Mesothelioma Treatment

Radiation is also a commonly used method to treat mesothelioma patients. In some cases, radiation is performed as a curative multimodal mesothelioma treatment regimen to increase life expectancy but may also be used as a palliative treatment.

Multimodal radiotherapy options may include:

External Beam Radiation – “traditional” radiation which is used at all stages of mesothelioma. As part of a multimodal therapy plan, it may significantly improve life expectancy and may relieve symptoms and reduce pain. It may be used before surgery to reduce tumor size or may be used after surgery to ensure that all cancer cells are killed.
Intensity-Modulated Radiation Therapy – a specific targeting method known as Intensity-Modulated Radiation Therapy (IMRT) may be more effective at targeting specific tumor areas while minimizing damage to healthy tissues. It may be used before surgery to reduce tumor size or may be used after surgery to ensure that all cancer cells are killed.
Intraoperative Radiation Therapy – Intraoperative Radiation Therapy (IORT) involves the application of radiation, directly to tumors during a surgical procedure. IORT is used in early stages of mesothelioma and allows doctors to treat the tumor directly without risk to covering tissues which are healthy.

Emerging Technologies as Part of Multimodal Mesothelioma Treatment

Mesothelioma is a rare cancer with only 3,000 new cases diagnosed each year. Though the disease was not widely recognized until the 1970s and 80s, treatment for the aggressive cancer has improved dramatically. New technologies, medications and procedures are constantly in development to increase the effectiveness of mesothelioma treatment. Some recent advances have included procedures which are now in regular use such as IMRT, IORT, and HIPEC.

Scientists continue to develop additional options such as medications which are individualized based on patient DNA profile, medications to increase tumor sensitivity to radiation, medication to protect healthy tissue from radiation so that higher doses may be used, and immunomodulators which may encourage the body to fight cancer on its own.

Because the cancer is so rare, not all physicians, oncologists or surgeons will have adequate experience treating mesothelioma. It is highly recommended that patients diagnosed with mesothelioma seek advice or treatment from a mesothelioma specialist. Physicians who specialize in the treatment of mesothelioma are often the best source of new information. They may be directly involved in the conduct of investigational trials to study new treatment methods. Not every patient will be eligible for investigational studies but patients who qualify may benefit from accessing newer methods through their mesothelioma specialists.