Intraoperative Chemotherapy and Radiation

What was initially a controversial approach to treatment, intraoperative chemotherapy and radiation has become more commonplace due to its life extending benefits. These treatments are applied directly to the location of a patient’s cancer while they are undergoing a surgical procedure. The purpose of intraoperative treatments is to kill any remaining microscopic mesothelioma cells after visible tumors are removed.

Dr. Paul Sugarbaker pioneered intraoperative chemotherapy, known as hyperthermic intraperitoneal therapy (HIPEC), for patients with a diagnosis of peritoneal mesothelioma.

Although there are still those in the medical community who are critical of the procedure, the success rates and survival rates are constantly improving. One study showed that those who had an operative cytoreductive surgery with HIPEC doubled their 2-year survival rate. Survivors like Alexis Kidd have this treatment to thank for their recovery.

Dr. Paul Sugarbaker’s brother, Dr. David Sugarbaker, has also used intraoperative chemotherapy in patients with pleural mesothelioma after having an extrapleural pneumonectomy. For those who opt for the alternative to the EPP, pleurectomy with decortication, intraoperative radiation is used to kill remaining cancer cells. Get connected with top specialists using our free Doctor Match program.

source : https://www.mesotheliomaguide.com/treatment/multimodal-therapy/

Combining Surgery With Traditional Cancer Treatment

Adjuvant chemotherapy is used to destroy mesothelioma cells that doctors were unable to remove with surgery alone. This type of multimodal chemotherapy treatment is also responsible for longer survival times in mesothelioma patients.

The idea behind neoadjuvant therapy is to shrink any tumors before attempting surgery. Therefore the chemotherapy is administered with the intention of having a future surgical procedure.

Chemotherapy and radiation therapy are the most well-known and traditional treatment methods for patients with all types of cancer. These traditional treatment methods haven’t always been the most effective for mesothelioma patients, but multimodal treatment methods are changing that.

It wasn’t long ago that chemotherapy didn’t have much effect for mesothelioma patients. However, the introduction of new chemotherapy drugs a little over a decade ago has given patients and families cause for hope. Furthering the cause for hope is the way chemotherapy is being administered in addition to surgical treatment.

Neoadjuvant and Adjuvant Chemotherapy

One of the best developments in treating mesothelioma with multiple modes of therapy is the use of neoadjuvant and adjuvant chemotherapy. Neoadjuvant chemotherapy is chemotherapy that is applied prior to surgery whereas adjuvant chemotherapy is administered post-surgery.

Neoadjuvant Therapy

A study in 2004 in 16 patients in varying stages of mesothelioma who had chemotherapy prior to an extrapleural pneumonectomy resulted in several patients living over 3 years, while the median survival for this group was just under 2 years from the date of the surgery.

Adjuvant Chemotherapy

As multimodal therapy is used in essentially all patients who undergo surgery, it is up to the mesothelioma specialist to decide whether neoadjuvant or adjuvant chemotherapy is more appropriate for the patient. However, adjuvant chemotherapy is often replaced with adjuvant radiation therapy, especially in patients who had a pleurectomy with decortication or patients undergoing a trimodality approach.

source: https://www.mesotheliomaguide.com/treatment/multimodal-therapy/

Mesothelioma Treatment Options

There are treatment options available for patients with all stages of mesothelioma and include surgery, chemotherapy, radiation and new clinical options.
Doctors offer three primary types of treatment to malignant mesothelioma patients: Surgery, chemotherapy and radiation. The types of treatment you receive depend on your diagnosis, the stage and type of your mesothelioma and your overall health.

If the cancer has not yet spread, a combination of radiation, surgery and chemotherapy likely will be offered to you. This combined approach to treatment is called multimodal therapy.

If the mesothelioma already has spread significantly, doctors typically recommend palliative treatments that can help alleviate pain, breathing problems and other cancer symptoms that lessen your quality of life. You are still likely to be offered radiation and chemotherapy, but probably not major surgery options.

Radiation therapy can soothe pain and correct breathing issues by shrinking tumors that press on your nerves, veins and airways. Chemotherapy also shrinks tumors, helping with chest pain and night sweats. Non-curative surgeries can remove tumors that cause troublesome symptoms, or drain fluid that builds up in the chest or abdomen.

You may also want to talk to your doctor about other treatment options beyond surgery, chemotherapy and radiation therapy. Experimental treatments exist, mostly in clinical trials, and sometimes they can make a huge difference.

Some patients also pursue alternative treatments like massage therapy, acupuncture or yoga. These can often be added to standard treatments like chemotherapy, so talk with your doctor about which therapies you'd like to explore.


What Are My Treatment Options?

There are several treatment options for patients with mesothelioma, from surgery to chemotherapy. These treatment options are not typically considered a cure for mesothelioma patients, although patients have reached remission in certain cases. These cases are typically situations where the disease was caught in the earliest stages and treated aggressively by a specialist.

Surgery
Surgical options are available for both curative and pain-relief purposes for all types of mesothelioma. Recovery from surgery can last several weeks.

Chemotherapy
Chemotherapy is an effective and viable form of treatment viable for patients with all 4 stages of malignant mesothelioma.

Radiation
Radiation therapy can be used before and after surgery to help shrink tumors and kill remaining cancer cells in a specific area of the body.

Mesothelioma Multimodal Treatment
Multimodal Treatment
Aggressive surgical treatments combined with chemotherapy and radiation have increased the life expectancy of many patients.

Mesothelioma Clinical Trials
Clinical Trials
Clinical trials offer patients access to emerging treatments such as immunotherapy treatments, gene therapy and photodynamic therapy.

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https://www.mesotheliomaguide.com/treatment/

Complementary Mesothelioma Treatments

Treatment for mesothelioma is usually provided by a combination of surgery, chemotherapy, and radiation, or by an emerging treatment such as immunotherapy or gene therapy. However, complementary treatments can provide additional relief from symptoms or help patients during recovery after their primary treatment is delivered.

Palliative Care

In cases where a cure for mesothelioma is not likely, such as with a Stage 4 diagnosis when the cancer has spread throughout the body, palliative care may still be an option. This type of care uses many of the techniques described above, but focuses on relieving the pain and suffering of the patient, rather than trying to eradicate the disease.

For example, one of the most debilitating symptoms of pleural mesothelioma is the build-up of fluid in the pleural space around the lungs. This collection of fluid makes it very difficult to breathe and also can cause severe pain. It greatly impacts the quality of life for the patient and can make it difficult to do every day tasks. The best way to relieve this discomfort is to have the fluid removed by means of a pleurocentesis.

In addition to or as an alternative to invasive procedures, medication to help with pain, difficulty breathing, and other symptoms that may be experienced is often prescribed. Click on the following link to learn more about pain management as well as its associated risks.

Physical Therapy

After the primary treatment, physical therapy is often required to help patients recover from the trauma of the treatment itself. The specific form of physical therapy a patient undergoes will depend on the specific type of treatment they receive, and how their body reacts to it. Common types of physical therapy include cardiovascular training, scar tissue healing, fatigue management, and strength training. While physical therapy will not necessarily help eradicate cancer or prevent recurrence, it can improve a mesothelioma survivor’s quality of life and overall health.

Alternative Therapies

Many patients have found relief from physical and emotional symptoms through different forms of alternative treatment, including everything from massage and acupuncture to yoga and art therapy. The important thing is to consult your doctor before trying one of these alternative treatments, to make sure it will not interfere with your primary treatment plan.

source: http://www.mesothelioma.com/treatment/

Standard And Experimental Mesothelioma Treatments

Treatment for mesothelioma typically involves a combination of surgery, chemotherapy, and radiation therapy. In cases where standard treatments do not work, mesothelioma patients may also be able to try experimental treatments through clinical trials.

While no cure currently exists, mesothelioma patients can usually improve their prognosis through some form of treatment. Even in cases where improving lifespan is not viable, palliative care and alternative therapies often help reduce pain and suffering from symptoms for many individuals with mesothelioma.

Standard Mesothelioma Treatments
The three standard therapies used to treat mesothelioma include surgery, chemotherapy, and radiation. In many cases, mesothelioma specialists will recommend a multimodal approach, which uses a combination of these three types of treatment.

Important considerations in determining a mesothelioma treatment plan include the cancer stage, primary site affected and cell type. Treatment options also depend on whether the cancer is localized to the chest or has spread to the chest wall, diaphragm, or lymph nodes as well as your age and overall health.

Experimental Mesothelioma Treatments
In addition to more conventional therapies, researchers are constantly looking for new ways to treat mesothelioma patients. Some extremely promising emerging treatments have come out of clinical trials, in some cases extending the lives of mesothelioma patients by months or years.

Immunotherapy
By kickstarting or boosting the immune system, it is possible to enhance the body’s own defenses against cancer.

Gene Therapy
Since cancer is caused by faults in cell DNA, one new way of fighting cancer is by fixing or overwriting problematic genes.

Photodynamic Therapy
Through the novel use of light and photosensitizing drugs, researchers have found a way to kill cancer cells with few side effects.

Source : http://www.mesothelioma.com/treatment/

New Study Shows DNA Screening Can Help With Mesothelioma Treatment

GERMANY - A recently published study shows DNA screening could help doctors more effectively treat mesothelioma patients using platinum-based chemotherapy regimens. Several key genes have been marked as helpful in predicting patients’ responses to their treatments.

The study is called “Screening of Pleural Mesotheliomas for DNA-damage Repair Player by Digital Gene Expression Analysis Can Enhance Clinical Management of Patients Receiving Platin-Based Chemotherapy.”

Chemotherapy was developed in the 1940s and is one of the most widely employed treatments for all types of cancer. Today, over 100 chemotherapy drugs exist on the market. Common chemotherapy drugs used to treat mesothelioma include Alimta, Cisplatin, Carboplatin, Gemcitabine, Onconase, and Navelbine.

Poor efficacy is related to chemotherapy because platinum-compound agents work by inducing damages in the DNA of cancer cells. So the ability of cells to detect and repair the damages could be one of the characteristics that can help predict a patient’s outcome after chemotherapy.

Results in the patients showed DNA damage response “plays a crucial role” in how well mesothelioma cells respond to chemotherapy.

Twenty-four malignant pleural mesothelioma patients participated in the study. Twelve patients got Alimta/Platinol or Alimta/Platinol/Paraplatin after surgery. The other 12 got Platinol followed by Alimta before surgery.

Thirty genes were identified as being related to the cell’s ability to recognize and repair DNA damage. Several of these were associated with mesothelioma spread, treatment response, and overall survival.

Lead author of the study, Dr. Robert Fred Henry Walter of the University of Duisburg-Essen wrote, “CDC25A and PARP1 gene expression were correlated with lymph node spread, BRCA1 and TP73 expression levels with higher IMIG stage.”

Also, it was found that mesothelioma tumor progression may be linked to CHECK1 and XRCC2 expression.

“After a prospective validation, these markers may improve clinical and pathological practice, finally leading to a patient’s benefit by an enhanced clinical management,” concluded the report.

This is another example of a promising experimental therapy to come out of a clinical trial. The next step in determining whether this is a viable and effective treatment is to validate the markers in mesothelioma patients for eventual use in clinical practice.

New Study: Asbestos Exposure on Commercial Ships

A new study on the health risks of asbestos exposure to seamen working on commercial ships was recently published in the medical journal Inhalation Toxicology. According to the results of the study, asbestos exposure is believed to have occurred due to repairs to the ships and maintenance tasks throughout the time that seamen worked on these non-military vessels.

The study measured airborne asbestos on merchant ships and the resulting health of its merchants over time. Previous studies on the communications and actions of U.S. organizations concerning maritime health and safety were also taken into consideration.

According to the study, data from before 1970 was mostly based on studies of workers in manufacturing, milling, and mining industries that used asbestos. This is because in many cases, the health risks of asbestos exposure to merchant seamen were largely unknown until the 1970s and 1980s.

Although asbestos air levels were found to be below 1 f/cc for most repair and maintenance work, a few pleural abnormalities were discovered in some U.S. seamen. This raised a red flag for the U.S. government and several industry and labor organizations.

In the 1990s, increases in lung cancer and mesothelioma were found in studies of seamen, which led researchers to believe there was a causal link between asbestos exposure on ships for seamen and these lung diseases.

In 2008, a similar study was published on asbestos in maritime shipping vessels because the same level of review given to Navy sailors was not being given to merchant seamen, despite the fact that both groups have historically used many tons of asbestos to build and repair their vessels.

Asbestos was often used in sea vessels because it was an effective insulator to prevent condensation, reduce the ventilation needed to cool spaces, allow machinery to operate with decreased heat loss, and prevent workers from needing to come into contact with hot components.

Historical industrial hygiene data from maritime shipping vessels between 1978 and 1992 was used in the 2008 study, including oil tankers and cargo vessels that were docked and/or at sea. Although many samples were collected from suspected asbestos-containing materials, they were not taken during times when interaction with the materials would’ve occurred.

Results of the study showed asbestos levels were consistently below U.S. occupational standards and almost always below the current expectations of 0.1 f/cc. So the mere presence of undisturbed asbestos did not significantly increase exposure.

In 2003, a National Health Institute study concluded mesothelioma cancer should be considered an occupational disease for merchant mariners and that occupational asbestos exposure contributes to their increased cancer mortality.

Source : http://www.mesothelioma.com/news/2016/11/new-study-asbestos-exposure-on-commercial-ships-.htm