Treatment Option Overview
Standard treatment for all but localized mesothelioma is generally not
curative. Although some patients will experience long-term survival with
aggressive treatment approaches, it remains unclear if overall survival (OS) has
been significantly altered by the different treatment modalities or by
combinations of modalities. Extrapleural pneumonectomy in selected patients
with early stage disease may improve recurrence-free survival, but its impact
on OS is unknown.[1] Pleurectomy and decortication can provide
palliative relief from symptomatic effusions, discomfort caused by tumor
burden, and pain caused by invasive tumor. (Refer to the PDQ summary on Pain for more information.) Operative mortality from
pleurectomy/decortication is less than 2%,[2] while mortality from extrapleural
pneumonectomy has ranged from 6% to 30%.[1,3] The addition of radiation
therapy and/or chemotherapy following surgical intervention has not
demonstrated improved survival.[2] The use of radiation therapy in pleural
mesothelioma has been shown to alleviate pain in the majority of patients
treated; however, the duration of symptom control is short-lived.[4,5] Single-agent and combination chemotherapy have been evaluated in single and combined
modality studies. The most studied agent is doxorubicin, which has produced
partial responses in approximately 15% to 20% of patients studied.[6] 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.[6,7]. 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.
References
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Rusch VW, Piantadosi S, Holmes EC: The role of extrapleural pneumonectomy in malignant pleural mesothelioma. A Lung Cancer Study Group trial. J Thorac Cardiovasc Surg 102 (1): 1-9, 1991.
[PUBMED Abstract]
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Rusch V, Saltz L, Venkatraman E, et al.: A phase II trial of pleurectomy/decortication followed by intrapleural and systemic chemotherapy for malignant pleural mesothelioma. J Clin Oncol 12 (6): 1156-63, 1994.
[PUBMED Abstract]
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Sugarbaker DJ, Mentzer SJ, DeCamp M, et al.: Extrapleural pneumonectomy in the setting of a multimodality approach to malignant mesothelioma. Chest 103 (4 Suppl): 377S-381S, 1993.
[PUBMED Abstract]
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Bissett D, Macbeth FR, Cram I: The role of palliative radiotherapy in malignant mesothelioma. Clin Oncol (R Coll Radiol) 3 (6): 315-7, 1991.
[PUBMED Abstract]
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Ball DL, Cruickshank DG: The treatment of malignant mesothelioma of the pleura: review of a 5-year experience, with special reference to radiotherapy. Am J Clin Oncol 13 (1): 4-9, 1990.
[PUBMED Abstract]
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Weissmann LB, Antman KH: Incidence, presentation and promising new treatments for malignant mesothelioma. Oncology (Huntingt) 3 (1): 67-72; discussion 73-4, 77, 1989.
[PUBMED Abstract]
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Ong ST, Vogelzang NJ: Chemotherapy in malignant pleural mesothelioma. A review. J Clin Oncol 14 (3): 1007-17, 1996.
[PUBMED Abstract]
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