Pleurectomies and Surgery for Pleural Mesothelioma

Pleurectomies can also be performed for palliative care when the entire tumor cannot safely be removed but partial extraction could result in some relief of symptoms. Other types of palliative surgical procedures include centesis, pleurodesis, shunt placement and catheter placement. Endoscopies are also used.

Surgery alone is not considered a single-handed cure for pleural mesothelioma. Surgery is often followed by some other form of treatment, and for those tumors that are inoperable, other bimodal or trimodal treatment plans must be put in place, including chemotherapy, radiation or both. Though chemotherapy and radiation are often utilized to shrink or slow the growth of pleural mesotheliomas, neither is considered curative for this disease at this point in time. Other new approaches also being used include gene therapy, immunotherapy and photodynamic therapy, etc. Additionally, patients, together with their care team, can discuss the possibility of applying to be a part of clinical trials aimed at developing new treatments.

Chemotherapy can be given for patients who are not surgical candidates or it can be used in a neoadjuvant approach where the chemotherapy is given prior to surgery to shrink the tumor. Chemotherapy can also be given palliatively for pain control. It can be administered orally, intravenously or intrapleurally and a catheter or port is often utilized, and it is given in 3-4 week cycles where a recovery period follows each treatment. The use of chemotherapy usually includes negative side effects, some of which can be managed effectively with the help of your care team.

According to the American Cancer Society, most doctors use the Alimta/Cisplatin regimen as a first-line treatment for pleural mesothelioma patients who do not undergo surgery, however many other chemotherapy drugs are also used.

Radiation therapy, as an adjuvant to surgery, in lieu of surgery for the patient who is not a surgical candidate and in its palliative form to control symptoms, is another commonly used treatment of pleural mesothelioma. One specific example of the use of radiation in this disease is when IMRT (Intensity Modulated Radiation Therapy) is used to target residual cancer cells in the chest cavity following extrapleural pneumonectomy.

Radiation therapy can also have side effects including fatigue and skin changes as well as lung damage when chest radiation is a part of the treatment regimen. These effects are sometimes increased when radiation and chemotherapy are used together as is often the case in pleural mesothelioma. Your care team is equipped to help control many of these symptoms and should be contacted.

Nutritional therapy is also an important part of treating mesothelioma. Patients are encouraged to discuss their specific nutritional needs with their care team.

Patients should also discuss complementary or alternative therapies that you may have interest in before partaking in them. Together with your care team, you may be able to incorporate some of these methods while safely avoiding others.
Pleural mesothelioma is a rare and aggressive disease that requires a multi-faceted approach. Only the most commonly used treatments have been discussed in detail in this report. Please seek the advice of your care team for all of your options.