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Mesothelioma Surgery

Several types of surgery exist for treating mesothelioma. A pleurectomy/decortication removes part of the chest or abdominal lining and the surrounding tissue. Doctors most often use the pleurectomy as a palliative procedure to relieve pain and prevent pleural effusion, or the build-up of fluid between the lungs and the chest cavity. While a surgeon can remove a good deal of the tumor through pleurectomy, the procedure often leaves mesothelioma along the diaphragm and lungs. A more aggressive surgery, known as , removes an entire lung in order to remove the mesothelioma. In extrapleural pneumonectomy the surgeon removes the affected lung along with the lining and diaphragm on the affected side and the lining around the heart.

Chemotherapy

Chemotherapy uses drugs to kill meso cancer cells. Doctors may administer chemotherapy by pill or through a needle into a vein or muscle. Doctors can administer chemotherapeutic agents either systemically (through the blood stream) or intrapleurally (in the pleural cavity). When administered intrapleurally, the chemotherapy treatment is localized at the site of the tumor. The drugs used for chemotherapy are generally very toxic and are usually accompanied by serious side effects including nausea, vomiting, anorexia, hair loss, and exhaustion. Side effects vary depending on the particular drugs used for the chemotherapy.

Single-agent therapy utilizes only one drug in the chemotherapy regimen to treat the cancer. Several agents have demonstrated modest success in effectively treating mesothelioma. Doxorubicin, probably the most extensively studied agent, has a response rate in the 15 percent range, as do detorubicin, pirarubicin, and epirubicin. Other agents, such as carboplatin, mitomucin, cyclophosphamide, and ifosdamide have similar response rates ranging from 10 to 20 percent. Researchers have studies cisplatin in a number of trials and discovered an approximately 14 percent response rate. One small study of very high dose-intensity cisplatin demonstrated a 36 percent response rate, but the high responsiveness lasted only 2 to 8 months.

Because single-agent chemotherapy regimes have failed to show great effectiveness (response rates less than 20 percent), researchers have examined several combination regimens for treatment of patients with mesothelioma. Combinations including doxorubicin, cisplatine, mitoxantrone, and bleomycin have been reported to realize response rates of up to 44 percent. Such high response rates have not been consistent, and overall combination therapy yields response rates similar to singe-agent therapy.
A new agent, gemcitabine, in combination with cisplatin has showed promising results in a study conducted by Australian researchers. In their research, which included mesothelioma patients in Stages III and IV, the combination therapy reaped a 47 percent response rate with a response duration of 25 weeks. The researchers reported a one-year survival rate of 41 percent with this treatment.

Pemetrexed, a multitargeted antifolate (MTA) has shown promising results when combined with cisplatin. In addition, researchers are currently conducting promising studies of oxaliplatin/raltitrexed and cisplatin/irinotecan combinations. Other new agents researchers are now studying include bevacizumab and onconase both of which are considered novel drug treatment options.

With each new therapy development, doctors have another therapy tool with which to treat patients. The increase in options allows doctors and patients to more carefully tailor a chemotherapy regime that addresses the specific needs of the patient, including the stage of the mesothelioma and the patient's age.

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