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Pleural Mesothelioma Treatment Options
Extrapleural pneumonectomy is surgery to remove a diseased lung, part of the pericardium (membrane covering the heart), part of the diaphragm (muscle between the lungs and the abdomen), and part of the parietal pleura (membrane lining the chest). Extrapleural pneumonectomy may improve survival, but its impact on long-term survival is unknown. Aggressive treatment approaches help some people, but remains unclear if overall survival has been significantly altered by the different treatment modalities or by combinations of modalities.
Pleurectomy and decortication (removal of part or all of the external surface of the lung or mesothelium) can provide palliative relief from symptomatic effusions, discomfort, and pain caused by invasive tumor. There is always a risk with surgery, and statistics show that operative mortality from pleurectomy/decortication is <2%, while mortality from extrapleural pneumonectomy has ranged from 6% to 30%.
Radiation therapy and chemotherapy are usually done after surgery but they have not been effective in improving survival. Radiation therapy has been shown to alleviate pain in most patients although the duration of symptom control is short-lived.
Single-agent and combination chemotherapy have been evaluated in single and combined modality studies. Some combination chemotherapy regimens have been reported to have higher response rates in small phase II trials; however, the toxic effects reported are also higher, and there is no evidence that combination regimens result in longer survival or longer control of symptoms than single-agent regiments. Recurrent pleural effusions may be treated with pleural sclerosing procedures; however, failure rates are usually secondary to the bulk of the tumor, which precludes pleural adhesion due to the inability of the lung to fully expand.
Extrapleural pneumonectomy is surgery to remove a diseased lung, part of the pericardium (membrane covering the heart), part of the diaphragm (muscle between the lungs and the abdomen), and part of the parietal pleura (membrane lining the chest). Extrapleural pneumonectomy may improve survival, but its impact on long-term survival is unknown. Aggressive treatment approaches help some people, but remains unclear if overall survival has been significantly altered by the different treatment modalities or by combinations of modalities.
Pleurectomy and decortication (removal of part or all of the external surface of the lung or mesothelium) can provide palliative relief from symptomatic effusions, discomfort, and pain caused by invasive tumor. There is always a risk with surgery, and statistics show that operative mortality from pleurectomy/decortication is <2%, while mortality from extrapleural pneumonectomy has ranged from 6% to 30%.
Radiation therapy and chemotherapy are usually done after surgery but they have not been effective in improving survival. Radiation therapy has been shown to alleviate pain in most patients although the duration of symptom control is short-lived.
Single-agent and combination chemotherapy have been evaluated in single and combined modality studies. Some combination chemotherapy regimens have been reported to have higher response rates in small phase II trials; however, the toxic effects reported are also higher, and there is no evidence that combination regimens result in longer survival or longer control of symptoms than single-agent regiments. Recurrent pleural effusions may be treated with pleural sclerosing procedures; however, failure rates are usually secondary to the bulk of the tumor, which precludes pleural adhesion due to the inability of the lung to fully expand.
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