Chemotherapy for malignant mesothelioma

Chemotherapy (chemo) is treatment with anti-cancer drugs. There are 2 main ways that chemotherapy can be given to treat mesothelioma. 

In systemic therapy, chemotherapy is injected into a vein. The drug enters the bloodstream and travels throughout the body to reach and destroy the cancer cells wherever they may be.

Chemo drugs can also be placed directly into the body cavity where the cancer is – either intrapleurally (directly into the chest) or intraperitoneally (into the abdomen) – with a small catheter (tube) placed through a small cut in the chest or abdominal wall. Chemo drugs given this way are still absorbed into the bloodstream, but the highest concentration of the drug goes directly to where the cancer cells are. 

Chemo drugs are sometimes heated before they are placed directly into a body cavity (called hyperthermic chemotherapy), which may help them work better. Sometimes this treatment is given as a single dose in the operating room, right after surgery to remove the cancer. This approach is called heated intraoperative chemotherapy or HIPEC. It is more often used to treat peritoneal cancers, in which case it may be called heated intraperitoneal chemotherapy.

Radiation therapy for malignant mesothelioma

Radiation therapy uses high-energy x-rays or particles to kill cancer cells. Mesotheliomas are often hard to treat with radiation therapy. They are not usually contained as single, discrete tumors, so aiming radiation at them while avoiding nearby normal tissues is difficult. But new radiation therapy techniques may make this form of treatment more useful.

Uses of radiation therapy

Radiation therapy may be used in different ways to treat mesothelioma:

• It can be used after surgery to try to kill any small areas of cancer that could not be seen and removed during surgery. This is called adjuvant radiation therapy.
• It can be used as a palliative procedure to ease symptoms of mesothelioma such as shortness of breath, pain, bleeding, and trouble swallowing.

Types of radiation therapy

Two main types of radiation therapy can be used to treat mesothelioma:

External beam radiation therapy (EBRT): This type of radiation therapy uses x-rays from a machine outside the patient’s body to kill cancer cells. It is the most common form of radiation therapy for mesothelioma. 

Palliative procedures used for malignant mesothelioma

Surgery to remove the cancer is not always an option for patients with malignant mesothelioma. In that case, less invasive procedures can be used to control some of the symptoms caused by mesothelioma, especially those due to built up fluid.

Removal of fluid

Procedures such as thoracentesis, paracentesis, and pericardiocentesis can be used to remove fluid that has built up and is causing symptoms. In these procedures, a doctor uses a long, hollow needle to remove the fluid. These procedures are described in the section, “How is malignant mesothelioma diagnosed?” The major drawback to these techniques is that the fluid often builds up again, so they may need to be repeated.

Pleurodesis

This procedure may be done to try to prevent fluid from building up in the chest. A small cut is made in the skin of the chest wall, and a hollow tube (called a chest tube) is placed into the chest so that the fluid can drain out. Then the doctor uses the tube to put a substance into the chest, such as talc mixed in a fluid (talc slurry), the antibiotic doxycycline, or the chemotherapy drug bleomycin. This inflames the linings of the lung (visceral pleura) and chest wall (parietal pleural) so that they stick together, sealing the space and preventing further fluid buildup. The tube is generally left in for a day or two to drain any new fluid that might accumulate. Pleurodesis can also be done at the time of thoracoscopy, either using the drugs doxycycline or bleomycin, or by blowing talc powder into the chest cavity. 

Surgery for malignant mesothelioma

Surgery for mesothelioma may be done for 1 of 2 reasons:

• To try to cure the cancer
• To relieve (palliate) pain and other symptoms caused by the tumor

Surgery to try to cure the cancer is known as potentially curative surgery. This type of surgery may be an option if you are in otherwise good health and the cancer has not spread too far to be removed completely. Unfortunately, even when the surgeon can remove all of the cancer that can be seen, some cancer cells are often left behind. These cells can grow and divide, causing the cancer to come back after surgery. Because of this, not all doctors agree on the exact role of surgery. In most cases it is not likely to cure you but may extend your life. Still, potentially curative surgery is being done in some major cancer centers, and a small number of patients who have had the surgery have had long remissions of their disease.

Palliative surgery may be an option if the tumor has already spread beyond where it started and is difficult to remove completely, or if you are too ill for a more extensive operation. The goal of this surgery is to relieve or prevent symptoms, as opposed to trying to cure the cancer.

How is malignant mesothelioma treated?

This information represents the views of the doctors and nurses serving on the American Cancer Society’s Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

 

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

 

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don’t hesitate to ask him or her questions about your treatment options. If you have mesothelioma, your cancer care team will recommend one or more treatment options for you to consider. This is an important decision and you should take time to think about all of your choices. 

Survival statistics for mesothelioma

Survival rates are often used by doctors as a standard way of discussing a person's prognosis (outlook). Some patients want to know the survival statistics for people in similar situations, while others may not find the numbers helpful, or even don’t want to know them. If you don’t want to read about the survival statistics for mesothelioma, stop here and skip to the next section.

To get survival rates, doctors have to look at people who were treated at least several years ago. Although the numbers below are among the most current we have available, improvements in treatment since then could result in a more favorable outcome for people now being diagnosed with mesothelioma.

Survival rates are often based on previous outcomes of large numbers of people who had the disease, but they cannot be used to predict what will happen in any particular person’s case. Knowing the type and the stage of a person’s cancer is important in estimating their outcome. But many other factors can affect survival, such as a person’s age and overall health, the treatment received, and how well the cancer responds to treatment. Even taking these other factors into account, survival rates are at best rough estimates. Your doctor can tell you if the numbers below apply, as he or she is familiar with your situation.