In a recent article in the medical journal Current Treatment Options in Oncology, researchers at Memorial Sloan-Kettering Cancer Center in New York, review the evolution of multi-modality therapy for malignant pleural mesothelioma. Pleural mesothelioma affects the lining of the lung and chest cavity, also known as the pleura.
Approximately 3,000 people are diagnosed with malignant mesothelioma each year in the United States. 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 or MPM typically remains contained locally to the lining of the lung during much of its development. Malignant mesothelioma cells only spread to other parts of the body in the later stages of the disease. While pleural mesothelioma remain localized, surgeons often try to remove visible malignant tumors and use other treatments such as chemotherapy and radiation to manage the cancer.
The two types of surgery that mesothelioma patients may undergo are:
• Pleurectomy-decortication, a procedure that strips away the diseased membrance lining the lung and visible tumors but spares the lung;
• Extrapleural pneumonectomy, 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.
Even after radical surgery, the cancer researchers say, mesothelioma almost always recurs locally. So many doctors have combined other treatments with surgery to combat the aggressive asbestos cancer. They typically administer radiation to a patient’s chest to try 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.
According to the article, the radical surgery, extrapleural pneumonectomy, 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 New York cancer researchers note that a large retrospective study comparing outcomes of patients who underwent an extrapleural pneumonectomy to those who had a pleurectomy-decortication showed better outcomes among patients who the latter surgery that spared their lung. Advances in administration of high-dose radiation have allowed targeted radiation therapy for patients who undergo a pleurectomy decortication.
The researchers conclude that mesothelioma clearly requires a multi-pronged response. Because of many unanswered questions with malignant pleural mesothelioma, much attention remains on identifying the ideal combination of surgery, chemotherapy and radiation.