Mesothelioma remains an incurable cancer, and long-term survival is uncommon. Surgery to remove the pleura, ipsilateral lung, phrenic nerve, hemidiaphragm, and pericardium combined with chemotherapy or radiation therapy may be considered, although it does not substantially change prognosis or survival time. No treatment substantially prolongs survival. Survival from time of diagnosis averages 8 to 15 mo, depending on the location and cell type. A few patients, usually younger patients with shorter duration of symptoms, have a more favorable prognosis, sometimes surviving for several years after diagnosis.
Treatment
Supportive care
Pleurodesis or pleurectomy for pleural effusions and relief of dyspnea
Analgesia with opioids and sometimes radiation therapy
Chemotherapy for tumor shrinkage and symptom relief
Experimental therapies
Complete surgical resection usually is not feasible. Combination pemetrexed (an antifolate antimetabolite) and cisplatin shows promise but warrants further study.
The major focus of treatment is supportive care and relief of pain and dyspnea. Given the diffuse nature of the disorder, radiation therapy is usually unsuitable except to treat localized pain and for needle-tract metastases. It is not generally used for treatment of nerve root pain. To help reduce dyspnea caused by pleural effusions, pleurodesis or pleurectomy can be used. Adequate analgesia is important but difficult to achieve. Usually opioids, both transdermal and delivered via indwelling epidural catheters, are used. Chemotherapy using cisplatin
relieves symptoms in most cases and sometimes decreases tumor size. Multimodality therapies are advocated by some authorities. Intrapleural injection of granulocyte-macrophage colony-stimulating factor or interferon-γ1b, IV ranpirnase (a ribonuclease), and gene therapies are under study.
In some cases, surgery maybe done to alleviate symptoms. For the most part treatment is supportive care. However, more recently, the use of combination chemotherapy with cisplatin and pemetrexed has been demonstrated to improve symptoms and overall survival. It is still, for the most part, thought to be an incurable disease, so all of the treatments are aimed at palliation (or improving symptoms).
How is mesothelioma treated?
Mesothelioma remains an incurable cancer, and long-term survival is uncommon. Surgery to remove the pleura, ipsilateral lung, phrenic nerve, hemidiaphragm, and pericardium combined with chemotherapy or radiation therapy may be considered, although it does not substantially change prognosis or survival time. No treatment substantially prolongs survival. Survival from time of diagnosis averages 8 to 15 mo, depending on the location and cell type. A few patients, usually younger patients with shorter duration of symptoms, have a more favorable prognosis, sometimes surviving for several years after diagnosis.
Treatment
Supportive care
Pleurodesis or pleurectomy for pleural effusions and relief of dyspnea
Analgesia with opioids and sometimes radiation therapy
Chemotherapy for tumor shrinkage and symptom relief
Experimental therapies
Complete surgical resection usually is not feasible. Combination pemetrexed (an antifolate antimetabolite) and cisplatin shows promise but warrants further study.
The major focus of treatment is supportive care and relief of pain and dyspnea. Given the diffuse nature of the disorder, radiation therapy is usually unsuitable except to treat localized pain and for needle-tract metastases. It is not generally used for treatment of nerve root pain. To help reduce dyspnea caused by pleural effusions, pleurodesis or pleurectomy can be used. Adequate analgesia is important but difficult to achieve. Usually opioids, both transdermal and delivered via indwelling epidural catheters, are used. Chemotherapy using cisplatin
relieves symptoms in most cases and sometimes decreases tumor size. Multimodality therapies are advocated by some authorities. Intrapleural injection of granulocyte-macrophage colony-stimulating factor or interferon-γ1b, IV ranpirnase (a ribonuclease), and gene therapies are under study.
In some cases, surgery maybe done to alleviate symptoms. For the most part treatment is supportive care. However, more recently, the use of combination chemotherapy with cisplatin and pemetrexed has been demonstrated to improve symptoms and overall survival. It is still, for the most part, thought to be an incurable disease, so all of the treatments are aimed at palliation (or improving symptoms).