Types of Pleural Mesothelioma Treatment

Treatment options are available to improve a mesothelioma prognosis using different methods and medications. Pleural mesothelioma treatment depends on the site (pleura, peritoneum, pericardium) and stage (I-IIII) of mesothelioma, a patient’s overall health, and the patient’s ability to receive and recover from treatment. Patients can receive a single form of treatment or a combination of methods, called multimodal therapy, including surgery, chemotherapy, radiation, immunotherapy, or targeted therapy.

The three primary methods of mesothelioma treatment are surgery, chemotherapy, and radiation. Doctors choose to administer the treatments curatively (to cure the disease) or palliatively (to relieve symptoms of mesothelioma). A doctor may suggest surgery to remove the affected tissues in the chest cavity. Chemotherapy or radiation kills any remaining tumors following surgery.

Extrapleural Pneumonectomy (EPP) For Pleural Mesothelioma Treatment

An extrapleural pneumonectomy procedure (EPP) is a surgical treatment that removes an entire lung and any nearby tissues affected by cancer. Pleural mesothelioma patients undergo open chest surgery if they have been diagnosed with early-stage cancer that has not spread to surrounding tissues. Early attempts of extrapleural pneumonectomy for treatment often failed prior to the 1930s. Today, pneumonectomies are backed by modern science and are safer. 

During an EPP, patients go under general anesthesia before the doctor makes a 10-inch incision at the front of the chest or on the side of the body. Once the surgeon removes the entire affected lung, they may remove other visibly cancerous tissues. The surgery takes an average of three hours to complete.

An EPP for pleural mesothelioma treatment is a more invasive surgery that comes with several risks, including a higher mortality rate of about 6% during or immediately after surgery. Risks associated with an EPP include:

  • Abnormal heart rate
  • Blood clots
  • Empyema (buildup of pus in the chest cavity)
  • Infection
  • Pneumonia
  • Hemorrhage or internal bleeding
  • Respiratory failure
  • Death

Benefits of EPP

A patient with a less severe prognosis may experience significant benefits if they take the risk of surgery. An EPP can significantly decrease or eliminate the risk for mesothelioma to spread (metastasis) outside the lungs and increase the lifespan of the patient. Some patients may experience improved symptoms of pleural mesothelioma, including the ability to breathe properly. Since patients must be in good health to undergo an EPP, several tests will determine if surgery is the best option. These tests may include:

  • Blood tests – Detects decreased organ function or signs of infection.
  • Echocardiogram (ECG) – Identifies abnormalities throughout the structure of the heart.
  • Imaging studies – Provides images of the chest cavity and lungs.
  • Pulmonary function tests – Assesses lung function.

Post-EPP, patients remain under the care of nurses and the surgeon for up to two weeks. The time spent in the hospital gives caregivers the chance to monitor the health of the patients and work on physical therapy, including breathing exercises and physical movements.

Pleurectomy and Decortication (P/D) For Pleural Mesothelioma Treatment

A pleurectomy and decortication (P/D) is a surgery to treat pleural mesothelioma. A P/D does not remove an entire lung but removes the lining of the lung, called the pleura, followed by the removal of visible tumors along the surface of the lungs and chest cavity. Patients must be in good overall health the recover from chest surgeries like P/D. Cancer patients are far less likely to die during or immediately after a P/D procedure compared to an EPP.

A pleurectomy used to be performed as a palliative option for pleural mesothelioma treatment. Now, doctors combine the procedure with decortication, which is the removal of visible tumors. This procedure takes several hours to complete.

During this procedure, the patient goes under general anesthesia before the surgeon makes an incision along the back or the side of the chest cavity. The surgeon removes the pleura and other tissue affected by mesothelioma including part of the diaphragm or pericardium. Additional incisions for access points may also occur to remove all visible tumors.

Recovery from a P/D typically involves a one-week hospital stay following the procedure. Patients can expect to recovery at home for the next four weeks. This procedure requires less recovery time, and patients can typically go back to normal activities after one month.

Deciding Between an Extrapleural Pneumonectomy and a Pleurectomy and Decortication

Choosing between an EPP and P/D surgery can be difficult for patients undergoing pleural mesothelioma treatment. Patients must consider personal preferences and advice from medical professionals. Each mesothelioma prognosis is different and requires different treatment options. Patients are good candidates for surgery based on the size and site of cancer tumors. 

The smaller, contained tumors set patients up better for success than in cases involving metastatic activity. If the tumors haven’t spread to the lungs from the pleural lining, doctors may recommend P/D. If the tumor spreads to the lung, a patient may undergo EPP. Imaging scans can help determine which surgery is best for pleural mesothelioma patients. The best option may not be guaranteed until a surgeon opens the patient’s chest cavity. 

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