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Mesothelioma Treatment Overview

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Treatment Option Overview

Standard treatment for all but localized mesothelio ma is generally not curative. Although some patients will experience long-term survival with aggressive treatme nt approaches, it remains unclear if overall survival has been significantly altered by the different treatment modalities or by combinations of modalities. Extrapleur al pneumonectomy in selected patients with early stage disease may improve recurrence-free survival, but its impact on overall survival is unknown. Pleurectomy and decortication can provide palliative relief from symptomatic effusions, discomfort caused by tumor burden, and pain caused by invasive tumor. Operative mortality from pleurectomy/decortication is less than 2%, while mortality from extrapleural pneumonectomy has ranged from 6% to 30%. The addition of radiation therapy and/or chemotherapy following surgical intervention has not demonstrated improved survival. The use of radiatio n therapy in pleural mesothelioma has been shown to alle viate pain in the majority of patients treated. However, the duration of symptom control is short-lived. Single agent and combination chemotherapy have been evaluated in single and combined modality studies. The most studied agent is doxorubicin, which has produced partial responses in approximately 15% to 20% of patients studied. Some combination chemotherapy regimens have been reported to have higher response rates in small phase II trials. However the toxicity reported is also higher and there is no evidence that combination regimens result in longer survival or longer control of symptoms. Recurrent pleural effusions may be treated with pleural sclerosing procedures; however, failure rates are usually secondary to the bulk of the tumor, which precludes pleural adhesion due to the inability of the lung to fully expand.

The designations in PDQ that treatments are ìstandardî or ìunder clinical evaluationî are not to be used as a basis for reimbursement determinations.

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