The diagnosis for malignant mesothelioma remains poor, although there have been some moderate progress in prognosis from newer chemotherapies and multi-modality management. Treatment of malignant mesothelioma at early stages has a better out come, but cures are exceedingly against the odds. Clinical behavior of the malignancy is affected by several factors including the contected mesothelial surface of the pleural cavity which favors local metastasis thought exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease. The histological subtype and the patient's age and health status also help predict prognosis.
Mesothelioma Surgery
Mesotheliom surgery, alone, has shown disappointing results. In a larger scientific study done at Duke University in 2008, the median survival with surgery including extrapleural pneumonectomy was only 11.7 months. In contrast, research indicates varied success when used in combination with radiation and chemotherapy. A pleurectomy or decortication is the most common surgery, in which the lining of the chest is removed. Less common and with more complication and risk is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed.
Mesothelioma Radiation Treatment
For patients with localized disease who are tolerant of radical surgery, radiation is often given post-operatively as a combined and complimentary treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. The thoracic oncology group of Brigham & Women’s Hospital in Boston, MA. was originally the pioneers of this approach of using surgery followed by radiation with chemotherapy. Combining radiation and chemotherapy after a radical surgery has led to extend life in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the interior chest wall.
Mesotheliom surgery, alone, has shown disappointing results. In a larger scientific study done at Duke University in 2008, the median survival with surgery including extrapleural pneumonectomy was only 11.7 months. In contrast, research indicates varied success when used in combination with radiation and chemotherapy. A pleurectomy or decortication is the most common surgery, in which the lining of the chest is removed. Less common and with more complication and risk is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed.
Mesothelioma Radiation Treatment
For patients with localized disease who are tolerant of radical surgery, radiation is often given post-operatively as a combined and complimentary treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. The thoracic oncology group of Brigham & Women’s Hospital in Boston, MA. was originally the pioneers of this approach of using surgery followed by radiation with chemotherapy. Combining radiation and chemotherapy after a radical surgery has led to extend life in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the interior chest wall.
