Mesothelioma

Author:
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....[MORE]