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Mesothelioma Treatment Overview
By:
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 t....[MORE]
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