Surgery is useful only when the diseased tissue is contained in a small area and the patient’s body is strong enough to withstand anesthesia and the surgical trauma. The two most frequently used mesothelioma treatments are radiation and chemotherapy.  However, some surgical treatments such as PD (pleurectomy decortication) and EPP (extra-pleural pneumonectomy)  often lead to longer survival times than just chemo or radiation therapies alone.

Chemotherapy for mesothelioma

Chemotherapy uses drugs to kill cancer cells. While it is sometimes the primary mesothelioma treatment, it usually is used as part of a combined (multi-modal) treatment strategy. Chemotherapy is a systemic treatment—drugs are enter the patient’s bloodstream and travel throughout the body killing mesothelioma cells. In addition to killing cancer cells, chemotherapy restricts the spread of abnormal cancer cells by preventing them from dividing and multiplying.

Chemotherapy is taken in pill form or by injection. It is not a cure for mesothelioma. Instead, it focuses on controlling the spread of the cancer cells, shrinking existing tumors before surgery (neoadjuvant therapy) and removing residual cancer cells after surgery (adjuvant therapy).

For the most effective treatment, a combination of drugs is usually administered in mesothelioma chemotherapy.  Alimta (pemetrexed) is the most common chemotherapy agent used in treating pleural mesothelioma.  Alimta is usually  combined with  cisplatin or carboplatin because these platinum-based compounds have synergistics effects with pemetrexed.  Chemotherapy agents used in different combinations include:

Carpoplatin Cisplatin Cyclophosphamide Doxorubicin

Epirubicin Gemcitabine Ifosfamide Methotrexate

Paclitaxel Pemetrexed Vinorelbine

Chemotherapy side effects depend on the drugs, dosage, and treatments.

Radiation treatment for mesothelioma

The two radiation treatments for mesothelioma use X-rays to destroy cancer cells and shrink tumors:

• External radiation that comes from outside the body from a machine
• Internal (implant radiation) from radioactive materials placed in or around cancer cells via thin plastic tubes

Though radiation can be effective in easing pain and other symptoms, before considering radiation as a treatment doctors  review the size of the tumor and its proximity to other internal organs.  It is very difficult to use radiation to treat pleural mesothelioma, because radiation can damage the heart, lungs, liver, or other vital internal organs.