The Multitopic Blog

The usage of conventional therapy for the treatment of MM has not been very successful and patients have a median survival period of 6-12 months after presentation. The malignancy is affected by many factors including the continuous invasion of mesothelial surface of the pleural cavity which favors local metastasis through exfoliated cells and other organs within the pleural cavity which and the extremely long period before contact with asbestos and the development of the disease.

Surgery

Surgery both itself as well as along with pre and post-operative therapies has also not worked well. Pleurectomy/decortication a procedure in which the lining of the chest is removed is the most common surgery. Another way is an extrapleural pneumonectomy (EPP) where the lung, the inner lining of the chest, the hemi-diaphragm and the pericardium are removed. It is however impossible to remove the mesothelium, keeping the patient alive.

Radiation

Radiation is given post operations to patients with localized disease and to those who can tolerate a radical surgery. The hemi-thorax is given radiation therapy, sometimes along with chemotherapy. Radiation along with chemotherapy has led to increases life expectancy and some patients have survived for more than 5 years. As a curative approach, radiotherapy is applied to the sites of the chest drain, in order to prevent the growth of the tumor along the track in the chest wall.

Although generally radiotherapy as a sole curative treatment does not work, palliative treatments routines are used to relive symptoms caused due to tumor growth. The dose of radiation that would be required to threat mesothelioma which has not been removed by surgery, would be very toxic.

Chemotherapy

The United States Food and Drug Administration approved pemetrexed as a drug to be used in the treatment of malignant pleural mesothelioma and is give along with cisplatin and folic acid to reduce its side effects.

Immunotherapy

http://www.tirgan.com/intrluk.htmImmunotherapy has also given variable results like intrapleural inoculation of Bacillus Calmette-Guerin while attempting to boost the immune response was of no use while in vitro lysis by LAK following activation by interleukin-2 was successful, though the patients experienced side effects. It was for this reason that trials have been suspended. Other trials with interferon alpha have had better results with more than 50% reduction in the tumor with minimal side effects for 20% of patients.

Heated Intraoperative Intraperitoneal Chemotherapy

Paul Sugarbaker of the Washington Cancer Institute developed as procedure called heated intraoperative intraperitoneal chemotherapy. In this the surgeon removes as much of the tumor as is possible through chemotherapy with the use of a chemotherapy agent in the abdomen.

Through this technique high concentration of selected drugs can be given in the abdominal and pelvic surfaces. Heating of the chemotherapy agent increases the chance of the drugs entering the tissue and there is greater chance of the malignant cells being destroyed due to heating than normal cells.