Mesothelioma Questions

Treatment of mesothelioma includes surgery, chemotherapy, radiation, and a combination of the three, termed trimodality therapy.  Surgical intervention can be diagnostic and  palliative but rarely curative.  Surgical procedures include pleurodesis, pleurectomy, and extrapleural pneumonectomy.  Radiation therapy is difficult in mesothelioma because of the sensitivity of local organs to radiation, but can still provide local palliation in almost 50 percent of patients.  Chemotherapy is rarely used alone but is an important part of trimodality therapy, which has produced the most favorable results.  This approach combines the use of surgery, typically extrapleural pneumonectomy, with chemotherapy and postoperative radiation.  Patients must undergo extensive evaluation before this treatment option is considered, including chest MRI, echocardiography and full pulmonary function testing.  Patients older than 55 years may not be candidates because of increased perioperative mortality.  New therapeutic approaches include intracavitary therapy, where compounds are delivered directly into the pleural space, and gene therapy.