Treatment Options for Malignant Mesothelioma

If you have mesothelioma, your cancer care team will recommend one or more treatment options for you to consider. This is an important decision and you should take time to think about all of your choices.

In addition to the stage of the cancer, your health and your personal preferences are factors in deciding on a treatment plan. Because mesothelioma is such a rare cancer, it has been difficult for doctors to compare the value of different treatments. Only a few large clinical trials have been reported to date. In addition, most doctors have little or no experience treating this disease. They usually refer patients with this cancer to specialists who treat a large number of mesothelioma patients in large medical centers.

Another problem with treating mesothelioma is that it does not grow as a single tumor mass. It tends to spread along nearby surfaces, nerves, and blood vessels. Because of this it is almost impossible, except in rare situations, to completely get rid of it with surgery, radiation or both.

Because treatment has resulted in modest benefit, you may question the treatment options suggested. It is often a good idea to seek a second opinion. A second opinion can provide more information and help you feel more confident about the treatment plan that you choose. Also, some insurance companies require a second opinion before they will agree to pay for certain treatments.

• Pleurectomy and decortication, with or without radiation therapy, as palliative therapy to relieve symptoms and improve the quality of life.
• Extrapleural pneumonectomy.
• Radiation therapy as palliative therapy to relieve symptoms and improve the quality of life.
• A clinical trial of anticancer drugs placed directly into the chest after surgery to remove the tumor.
• A clinical trial of combinations of surgery, radiation therapy, and chemotherapy.
• A clinical trial of a new treatment.

 This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the National Cancer Institute (NCI) Web site.

Advanced Malignant Mesothelioma (Stage II, Stage III, and Stage IV)
Treatment of advanced malignant mesothelioma may include the following:

• Surgery to drain fluid that has collected in the chest, to reduce discomfort. Pleurodesis may be done to stop more fluid from collecting in the chest.
• Pleurectomy and decortication, as palliative therapy to relieve symptoms and improve the quality of life.
• Radiation therapy as palliative therapy to relieve pain.
• Chemotherapy with one anticancer drug.
• A clinical trial of combination chemotherapy.
• A clinical trial of combinations of surgery, radiation therapy, and chemotherapy.
• A clinical trial of chemotherapy placed directly into the chest cavity or abdominal cavity to shrink the tumors and keep fluid from building up.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the National Cancer Institute (NCI) Web site.

Recurrent Malignant Mesothelioma
Treatment of recurrent malignant mesothelioma may include the following:

• A clinical trial of biologic therapy.
• A clinical trial of chemotherapy.
• A clinical trial of surgery.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the National Cancer Institute (NCI) Web site.