Mesothelioma Treatments
Multimodal Treatment
Doctors specializing in mesothelioma treatment frequently adopt a multimodal approach: they treat a patient with a combination of therapies. Due to the relative lack of effectiveness of single-modality treatment in affecting patient survival, the multimodal combination of treatments holds more promise for survival of malignant mesothelioma patients. For an over view of single-mode and multimodal treatment regimens, see the abstract of "Treatment of Malignant Mesothelioma" by M.T. Jaklitsch, S.C. Grondin, and D.J. Sugarbaker and published in the World Journal of Surgery in 2001.
Surgery (physical removal of the cancer)
There are several types of surgeries that may be available for mesothelioma. The disease type, stage and the individual’s age and condition will determine if and what type of surgery may be performed.
Chemotherapy (using drugs to fight the cancer)
Chemotherapy uses drugs to kill cancer cells and may be used as the primary treatment to mesothelioma, or it may be used as part of a multi-modal approach. Chemotherapy is referred to as systemic treatment because the drug is introduced into the patient’s bloodstream and travels throughout the body killing cancer cells. The drugs may be in pill form, or injected into the body through a needle.
Radiation Therapy (using high-dose x-rays to kill cancer cells)
Radiation therapy uses high-energy x-rays help to destroy cancer cells and shrink tumors. The radiation may come from outside the body from a machine (external radiation) or from radioactive materials placed directly in or around cancer cells through thin plastic tubes (internal or implant radiation).
In oncology, multimodal therapy or combined modality treatment refers to a combination of two or more methods of treatment. It most often refers to any combination of surgery, radiation therapy, and chemotherapy. If one form of treatment is considered the primary therapy and the other method is administered to assist in treating the cancer, the medical community refers to the secondary treatment as adjuvant therapy (1).
Certain cancers, such as breast cancer, are proven to be responsive to multimodal treatments, and in some cases combining therapies can increase patient survival rates. Other types of cancer, such as lung and esophageal cancer, are said to not respond to multimodal therapy, though because more research is needed, the data is not necessarily conclusive (1, 2). One major negative aspect of multimodal therapy is the increased stress and toxicity placed on the patient, and for this reason doctors and patients must weigh the options carefully (1).
In the case of mesothelioma patients, a multimodal approach is common because the disease responds with only limited success to unimodal forms of treatment. In the case of malignant pleural mesothelioma, for example, a multimodal treatment may involve a pleurectomy (the surgical removal of the lining of the lung), followed by localized dose of chemotherapy, and radiation treatment afterwards.
There are no large randomized clinical trials or randomized clinical data available for the use of chemotherapy in combination with radiation therapy in the treatment of malignant mesothelioma.
Cisplatin and Doxorubicin are active drugs in mesothelioma and also theoretically can act as a radio-sensitizers to bring more local control of mesothelioma. Paclitaxel has also been used in the setting of chemo radiation as a radio-sensitizer.
