Malignant pleural mesothelioma is the most common form of mesothelioma, beginning in the thoracic cavity and affecting about 75% of mesothelioma patients. There are many different treatment options for those who have been diagnosed and the ones that are used are chosen based on stages of the cancer and other factors.
Extrapleural pneumonectomy (EPP) has been widely used to treat patients with pleural mesothelioma in early stages and has been able to increase survival rates. An extrapleural pneumonectomy is a surgery to remove a diseased lung, in this case a lung that has been affected by mesothelioma, part of the membrane that covers the heart, a portion of the diaphragm and a portion of the parietal pleura, which is the membrane that lines the chest. Additionally, pleurectomy/decortication (P/D) has been used on pleural mesothelioma patients. A P/D involves taking out a portion of the pleura and then removing cancerous tissues and tumors from the surface of the lung. These forms of treatment are extremely helpful to patients, however, they usually result in the cancer coming back very quickly. Hyperthermic intrathoracic chemotherapy also known as HITHOC has been a relatively successful way of treating this type of mesothelioma, although it is not used as much as it is aggressive. This type of treatment involves local administration of cytotoxic therapy in the area where the pleura is located. HITHOC may be recommended for patients who have been through a pleurectomy/decortication as it tends to extend survival rates.
Most doctors consider HITHOC to be an experimental treatment. It can be utilized by patients who are able to undergo aggressive treatments, but may not be good for those who cannot. Other treatment options for those with pleural mesothelioma include radiation therapy, other surgeries, chemotherapy and other supportive treatments that are done to control the symptoms of advanced cancer. Normally, the type of treatment that is used is decided based on a variety of factors, such as the condition that the patient is in.
Chemotherapy might be used for patients who have early stage pleural mesothelioma and it is used to shrink or control the spread of the cancer. Radiation therapy may be used after surgery and is used to slow the growth of the cancer as well as to control symptoms. In order to have surgery, the patient is usually in relatively good physical condition in order to be able to recover well. A surgery that removes a part of the pleura, or the lining of the lung, is a partial pleurectomy. A surgery that removes all of the pleura is a pleurectomy, as mentioned earlier.
Removing part of the pleura is a really intense operation. This can be performed using keyhole surgery or making a large wound in the chest. After this surgery, patients typically remain in the hospital for about a week and it takes about a month or more to fully recover. As discussed earlier, a P/D is another operation that can be performed by a surgeon and it involves removing any mesothelioma that is visible, removing the pleura itself and removing the hardened outer layer of the surface of the lung.
Palliative care may also be utilized, specifically for patients that are in the later stages of mesothelioma in order to enhance their quality of life.
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Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5725050/
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/extrapleural-pneumonectomy
https://www.cancerresearchuk.org/about-cancer/mesothelioma/treatment/decisions-pleural
