Treatment Options For Localized Mesothelioma

Li Liu, MD
Last Modified: November 1, 2001

Question:

Dear OncoLink "Ask the Experts,"
My wife was recently diagnosed with pleural malignant mesothelioma. It was found in the left lung only and is said to be in an early stage. She is 56 and otherwise in good health. She has no asbestos exposure history and has never smoked.

We are still awaiting advice from a specialized clinic in the Netherlands. In the mean time I have been browsing the Internet, but found that various types of treatments are applied, partly experimental. This is rather confusing.

Therefore, kindly inform me which type of treatment gives the highest certainty of significantly prolonging her life. Our hope is that during this period possibly more permanent treatments are developed.
Thank you.
A.

Answer:

Li Liu, MD, OncoLink Editorial Assistant, responds:

Dear A,
Thank you for your interest and question.

Malignant mesothelioma can originate from the lining surrounding the lungs, the stomach, or the heart (mesothelium). While the most important risk factor is asbestos exposure, about 30% to 50% of cases of mesothelioma have no documented asbestos exposure (IARC Scientific Publication 1989;(90):219-28).

Standard treatment for all but localized mesothelioma is usually not curative. Depending on the stage of a mesothelioma and general condition of the patient, surgery may be used to remove the cancer and some of the surrounding tissue. Extrapleural pneumonectomy in selected patients with early stage disease may improve disease-free survival, but its impact on overall survival is unknown (Journal of Thoracic and Cardiovascular Surgery 1991 Jul;102(1):1-9). In the review, the operative death rate from such surgery ranged from 6% to 30% (Chest 1993 Apr;103(4 Suppl):377S-381S). Multimodality treatment including surgery followed by radiation therapy and/or chemotherapy has not resulted in improved survival (Journal of Clinical Oncology 1994 Jun;12(6):1156-63). For patients with early stage mesothelioma, surgical resection followed by immediate intracavitary photodynamic therapy has shown promising results (Annals of Thoracic Surgery 1998 Oct;66(4):1128-33). For patients with more advanced disease, better treatment modalities need to be developed. At this stage, most of the treatments for mesothelioma remain experimental. Clinical trials available for some patients may be found at the UPCC clinical trials database and the NCI clinical trials database .

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