Malignant mesothelioma is a rare and aggressive type of cancer that affects the lining of the lungs, abdomen, and heart. It is caused by exposure to asbestos, a naturally occurring mineral fiber that was widely used in construction and manufacturing until the 1970s. Mesothelioma has a poor prognosis, with a median survival time of 12 to 21 months following diagnosis. However, multimodal therapy, which combines two or more treatment modalities, has shown promise in improving survival rates and quality of life for mesothelioma patients.
Multimodal therapy typically includes a combination of surgery, chemotherapy, and radiation therapy. The specific approach may vary depending on the type and stage of mesothelioma, as well as the patient’s overall health and other factors. The goal of multimodal therapy is to remove as much of the cancer as possible, reduce the risk of recurrence, and improve symptoms and quality of life.
Surgery is often the first step in multimodal therapy for mesothelioma. The type of surgery will depend on the location and extent of the cancer. For pleural mesothelioma, which affects the lining of the lungs, the most common surgery is called pleurectomy with decortication (P/D). This involves removing the pleural lining and any visible tumors while preserving the lung tissue. Another option is extrapleural pneumonectomy (EPP), which involves removing the affected lung, the pleural lining, and other nearby tissues. EPP is a more extensive surgery that carries a higher risk of complications, but it may be necessary in some cases.
For peritoneal mesothelioma, which affects the lining of the abdomen, the standard surgery is called cytoreductive surgery with heated intraperitoneal chemotherapy (HIPEC). This involves removing all visible tumors from the abdominal cavity and then circulating heated chemotherapy drugs throughout the area to kill any remaining cancer cells.
Chemotherapy is typically used in conjunction with surgery to kill any remaining cancer cells and reduce the risk of recurrence. The most common chemotherapy drugs used for mesothelioma are cisplatin and pemetrexed. These drugs may be given intravenously or directly into the affected area using a catheter. Chemotherapy can cause side effects such as nausea, vomiting, hair loss, and fatigue, but these can often be managed with medication and other supportive measures.
Radiation therapy may also be used as part of multimodal therapy for mesothelioma. This involves using high-energy radiation to kill cancer cells and shrink tumors. Radiation therapy may be given before or after surgery, or as a standalone treatment for patients who are not candidates for surgery. The most common type of radiation therapy for mesothelioma is called intensity-modulated radiation therapy (IMRT), which allows for precise targeting of the cancer cells while minimizing damage to healthy tissue.
The effectiveness of multimodal therapy for mesothelioma varies depending on various factors such as cancer stage, patient overall health, and the specific treatment modality used. However, studies have shown that multimodal therapy can improve survival rates and quality of life for mesothelioma patients.
A 2019 study published in the Annals of Surgical Oncology looked at 72 patients with pleural mesothelioma who underwent P/D surgery and chemotherapy. The study found that the median overall survival time was 20.2 months, and the 2-year survival rate was 47.9%. Another 2019 study published in the Journal of Thoracic Oncology looked at 73 patients with pleural mesothelioma who underwent EPP surgery and chemotherapy. The study found that the median overall survival time was 23.6 months, and the 2-year survival rate was 45%. These are both significant improvements over the typical survival times for mesothelioma patients.
For peritoneal mesothelioma, a 2018 study published in the Journal of Clinical Oncology looked at 549 patients who underwent cytoreductive surgery with HIPEC. The study found that the median overall survival time was 63.4 months, and the 5-year survival rate was 47.2%. This is a substantial improvement over the typical survival times for peritoneal mesothelioma patients.
It is important to note that these survival rates are based on studies with specific patient populations and may not be representative of all mesothelioma patients. Additionally, multimodal therapy can be associated with significant risks and side effects, and not all patients are candidates for all treatment modalities. Therefore, it is essential to work with a knowledgeable and experienced mesothelioma treatment team to determine the most appropriate approach for each individual case.
In conclusion, multimodal therapy, which combines two or more treatment modalities, has shown promise in improving survival rates and quality of life for mesothelioma patients. Surgery, chemotherapy, and radiation therapy are typically used in combination to remove as much of the cancer as possible, reduce the risk of recurrence, and improve symptoms and quality of life. While survival rates varydepending on various factors, studies have shown that multimodal therapy can significantly improve survival times for mesothelioma patients. It is crucial to work with a knowledgeable and experienced mesothelioma treatment team to determine the most appropriate approach for each individual case, as multimodal therapy can be associated with significant risks and side effects, and not all patients are candidates for all treatment modalities. Overall, multimodal therapy represents an important advance in the treatment of mesothelioma and offers hope for improved outcomes for patients with this challenging disease.
