How to Compare Mesothelioma Treatment Options

A mesothelioma may be any tumor arising from the mesothelium, a cell layer that lines the body cavities. However, this term is most closely associated with tumors of the pleural cavity that are usually caused by asbestos exposure. Pleural mesothelioma usually starts as separate plaques that form a sheetlike tumor. The tumor also may extend to the diaphragm and the surface of the lungs, but a variety of treatment options are available.

Difficulty: Challenging

Instructions

1. Manage malignant mesothelioma with chemotherapy, radiation and surgery separately or with a multimodal therapy.

2. Provide anthracycline, alkylating agents and platinum as the most active agents against mesothelioma. Chemotherapy by itself has had limited success and these agents only have a response rate 10 to 20 percent. Other drugs are being tried in clinical trials and include cisplatin, which is sometimes combined with pemetrexed and gemcitabine.

3. Administer radiation primarily to relieve pain and control metastasis. Primary treatment of mesothelioma has been similarly disappointing.

4. Perform surgery most often when the mesothelioma is confined to the pleural cavity. The surgeries most often performed are a pleurectomy or an extrapleural pneumonectomy.

5. Use a trimodal approach that combines chemotherapy, radiation and surgery. One commonly used regimen involves a pneumonectomy followed by chemotherapy and radiation. Chemotherapy consists of a combination of medication like cisplatin, cyclophosphamide and doxorubicin. Radiation therapy is delivered as an external beam over five to six weeks. This program has a 45 percent survival rate for two years.

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