Wednesday, June 29, 2011

Multimodality Mesothelioma Therapy is Still the Best Option

Patient-centric treatment optimizes the potential for success of a patient’s care by offering the right treatment at the right time. This is especially vital for mesothelioma patients as the disease rapidly progresses to cause life-threatening complications, and can differ dramatically across patients. But before determining the optimal treatment for an individual, researchers need to gauge the efficacy of the available options.

In a recent article in the medical journal Current Treatment Options in Oncology, researchers at Memorial Sloan-Kettering Cancer Center (MSKCC) in New York, explore the benefits of the individual treatments for mesothelioma, as well as the three-pronged multi-mode approach using a combination of surgery, chemotherapy and radiation.

Mesothelioma, an asbestos-caused pulmonary cancer, is diagnosed in close to 3,000 Americans each year. Most are workers who breathed or ingested asbestos dust at at-risk workplaces in New York and elsewhere. Malignant pleural mesothelioma is by far the most common form of mesothelioma.

Malignant pleural mesothelioma typically remains contained locally to the lining of the lung during much of its development, but spreads, or metastasizes, to other parts of the body in the later stages of the disease. For localized mesothelioma, surgeons often try to remove visible malignant tumors and use additional treatments of chemotherapy and radiation to manage the remaining cancer.

The two most common surgeries are pleurectomy/decortication (P/D), a procedure that strips away the diseased membrane lining the lung and visible tumors but spares the lung; and extrapleural pneumonectomy (EPP), a more radical procedure that involves removal of a lung, the diseased lining of the chest cavity and heart, and a portion of the diaphragm. Which of the two surgeries to use on a patient is often debated in the medical community.

According to the article, the radical surgery, EPP, carries a significant incidence of patient mortality. Furthermore, many mesothelioma patients who survive radical surgery are too weakened to handle a full course of additional radiation and chemotherapy. The research found that those who had a P/D showed better outcomes among patients. Advances in administration of high-dose radiation have allowed targeted radiation therapy for patients who undergo the pleurectomy / decortication surgery.

Regardless of the surgery used, the MSKCC researchers say mesothelioma almost always recurs locally. To combat the aggressive asbestos cancer, oncologists typically follow the surgery with radiation to prevent the return of the localized cancer, and chemotherapy to reduce the risk of malignant cancer cells spreading to other parts of the body.

The researchers concluded that mesothelioma patients clearly benefit from multimodality therapy. The physician that best knows his patient should be able to determine the ideal combination of surgery, chemotherapy and radiation to personalize the mesothelioma care for optimal results.