The therapeutic approach depends on the stage, size and cell type of the tumor. The basis is based on a multimodal approach with a combination of surgery, chemotherapy and radiotherapy. Research is increasingly focusing on the introduction of new modalities, the most hope of which is immunotherapy. Several other forms of mesothelioma therapy are in the phase of development and research. Early stages have greater therapeutic effects and a greater choice of treatment approach.
Therapies Given to Meso patients
Hirugia – Based on removal of tumor mass; the first and second stages are operable when the tumor is still localized, in the later stages with metastases the surgery has a palliative benefit where the intervention allows the patient to relieve the existing symptoms and better quality of life. Operability is also affected by the size of the tumors, where they are large and localized less operable than the smaller masses, and also by the general condition of the patient. More invasive extrapleural pneumectomy is used which is more difficult for patients to tolerate with more complications but is believed to produce better results and pleuroctomy with decortication where the pleura, the portions of the surrounding tissue wall and the tumor mass that is less invasive are removed and preserve both lungs as opposed to pneumoctomy. There are also centers with robotic surgery that are more accurate and better than conventional thoracoscopy.
Chemotherapy – the most widely used treatment modality mesothelioma used in all stages. The most commonly used combination of cisplatin and permetrexate constituting the first line of chemotherapy. Sometimes used as a substitute for cisplatin, carboplatin is used where the same effect with slightly minor side effects has been reported. If they do not respond adequately , doxorubicin, gemcitabine, dacarbazine, vincristine or cyclophosphamide are included in therapy
Ionizing radiation of tumor mass is used to kill tumor cells, most commonly used to relieve symptoms in patients with later stages. In the stages of high tumor spread in the body, it is not the whole body that is treated but the focuses that endanger the patient’s breathing and cause pain. Also, this method is useful postoperatively or intraoperatively when the primary tumor site is treated in order to eliminate the remaining few malignant cells and prevent any recurrence. External radiotherapy (EBRT) is the most applicable where tissue is irradiated from an external source by a beam that is modified to shape and size of the tumor. Mesothelioma is quite sensitive to radiotherapy however due to the large volume of tumors, it is of limited use, mainly palliative to relieve symptoms of chest pain and dyspnea.
Immunotherapy – is still in the testing phase I studies but it is expected its expansion in the treatment of mesothelioma in the coming years. Passive immunotherapy of checkpoint inhibitors is being attempted, which are actually monoclonal antibodies that bind to immune cell molecules that participate in the unmasking of tumor antigens, thus making tumor antigens available to the immune system. Attempts have been made to extract and genetically modify autologous T lymphocytes that add chimeric antigen receptors that recognize key tumor antigens when administered to a patient, so far in mesothelioma therapy this is at the research level. Keytruda I In general, the drugs used in lung cancer therapy gave satisfactory results
Photodynamic therapy – three days before the thoracotomy, the patient is given a photosensitizer that eliminates quickly from healthy but remains longer in the malignant cells and after a thoracotomy with a laser of a specific wavelength, ie red, treats the tumor lesion and thus damages the malignant cells. Laser light does not have the ability to penetrate tissues and is therefore used during thoracotomy and for tumors of a certain thickness and adequate localization available.
Palliative and symptomatic therapy – used to improve quality of life and reduce the severity of symptoms. A major problem in these patients is recurrent pleural effusions that compromise pulmonary function and respiration and for this purpose aspiration of this excess fluid by thoracocentesis is used to drain it. A more durable solution but with side effects would be pleurodesis – a method by which the thoracocentesis of the tube distributes talc or bleomycin that leads to inflammation and closure of the pleural cavity. In severe cases, a pleuro-peritoneal shunt is introduced to transfer the fluid into the peritoneal cavity, which absorbs this excess fluid well.