When treating pleural mesothelioma, specialists use a multimodal approach. This means eligible patients receive chemotherapy and/or radiotherapy in addition to surgery. Using two or more treatments for pleural mesothelioma has shown to be the most effective approach for preventing recurrence (when the cancer comes back) and extending patient survival.
What Is Multimodal Therapy?
Mesothelioma is a devastating disease that is highly resistant to treatment. Doctors and researchers are continually trying to find new ways to combat it. At this time, the best way they've found to fight mesothelioma is by using a multimodal approach—combining more than one treatment type to develop a more comprehensive treatment plan.
In multimodal therapy, the central treatment is surgery for pleural mesothelioma. Patients with resectable mesothelioma (able to be removed surgically) will undergo either an extrapleural pneumonectomy (EPP) — removal of the lung — or a pleurectomy with decortication (P/D) — removal of cancer from the lung's lining.
The two most common types of therapy that patients receive with surgery are chemotherapy and radiation. However, patients may receive these therapies at different times during the overall treatment process.
For example, based on your particular circumstances, your doctor might recommend neoadjuvant treatments, intraoperative therapies, or adjuvant therapies:
- Neoadjuvant: When chemotherapy or radiotherapy happens before the surgery takes place
- Intraoperative: When doctors administer the additional treatments during the surgery
- Adjuvant: When the other forms of treatment occur after the operation has already taken place
Chemotherapy and radiotherapy can be adjuvant, neoadjuvant, or intraoperative. However, it’s a more common and standard approach to administer them adjuvantly (after the operation).
What Happens After Mesothelioma Surgery?
Patients with pleural mesothelioma who are eligible for surgery undergo either an EPP or a P/D. During surgery, doctors remove as much of the mesothelioma as possible. Even when doctors remove all visible signs of mesothelioma, it’s still likely to return. This is why the treatment for mesothelioma doesn't stop just because the surgery was successful.
After the surgery is over, the patients will receive post-surgical treatments (adjuvant) to try and kill off the remaining mesothelioma cells to prevent them from forming more tumors. The most common forms of adjuvant therapies are chemotherapy and radiotherapy.
While the ultimate goal of each treatment is to eliminate the remaining cancerous tissue, they use different methods, and they each have their risks and benefits.
Chemotherapy After Surgery
Mesothelioma tumors are not like most tumors. They do not form in a giant clump. Instead, they tend to spread out in tiny clusters across the lung and organ linings like a sheet. Because some tumors are too small to see, it’s impossible for a surgeon to remove them all. This is where chemotherapy comes in.
Using an IV, a chemotherapy cocktail—usually a combination of pemetrexed and cisplatin — is given to the patient. These drugs circulate through the patient’s bloodstream and kill off cells that divide quickly, like mesothelioma cells and hair cells. Patients receive 4-6 treatment cycles that each last 3 weeks.
Radiation After Surgery
Like chemotherapy, patients may receive radiation therapy after surgery to kill off remaining mesothelioma cells. However, because the radiation can damage healthy tissue around the area it is targeting, radiation therapy is generally only used after an EPP because there is no lung to potentially damage.
Fortunately, radiation technology is improving. Newer methods like intensity-modulated radiation therapy (IMRT) provide better accuracy. This means more radiation targets the mesothelioma cells and preserves the healthy tissue surrounding the tumor. A machine delivers a beam of radiation to the cancer site. Patients typically receive daily doses for several weeks at a time.
A recent study demonstrated that patients who received a combination of surgery and radiotherapy had a higher median survival rate. More patients were still alive 21.4 months post-surgery than those who only had surgery—the median survival rate was 16.6 months.
Treating pleural mesothelioma is a long and comprehensive process. But these treatments used in combination, are the best-known ways of extending survival at this time.