Mesothelioma information

Treatment can be done in three kinds they are:

Surgery
Radiotherapy
Chemotherapy



Role of surgery in Mesothelioma

Surgery has a very limited role because the patients usually present late, by which time there is often widespread pleural involvement. Very few patients can therefore be considered for surgical interaction.

There are two possible procedures. The first is a combined pneumonectomy and pleuro-percardectomy. This is a major operation which is only possible in a fit patient with good respiratory reserve and cardiac function and a tumor that has not invaded significantly beyond the parietal pleura. It is sometimes necessary to resect the diaphragm and replace it with a macron mesh.

Clearly, these limitations mean that the patients are highly selected and so, even in areas where the tumor is a very frequent, experience of the procedure will be quite limited. It is therefore assess its true value, particularly as it is associated with significant morbidity.

The second procedure is pleural stripping. Again the patients who are suitable for this treatment are those with caused disease and no significant partial pleural involvement, and it is therefore probably only appropriate for those who present with recurrent pleural effusion rather than chest wall pain. It is a less morbid procedure and its advocates claiming it as an effective way of controlling the problem of effusion but it is not clear whether it also confers any survival benefit.



Radiotherapy for Mesothelioma

It is widely believed that Mesothelioma is not at all responsive to radiotherapy. This is not entirely true. Certainly with most sarcomas, a high dose is probably needed to achieve any durable tumor control, but useful responses can be seen even with relatively low, palliative doses.
The typical presentation and pattern of spread over the pleural surface means that high dose, radical radiotherapy is technically difficult, because the volume has to be very large and may include substantial amounts of normal tissues such as lung heart and liver, that cannot tolerate the high dose needed. Techniques using combinations of megavoltage X-rays and electron seeds have been described, but they are inevitably complex and it is not clear whether they actually effective. Certainly there may be patients with a small volume of disease for whom radical radiotherapy might be an option but, as with surgery until techniques for early diagnosis improve they will remain extremely uncommon.

Radiotherapy does have a limited but useful role in the palliation of patients with Mesothelioma. Wide-field radiotherapy including the whole hemi thorax from midline to lateral chest wall can be given to a does of 30 gy in then fractions and provide reasonable,
If short-lived, improvement in pain, It is necessary to treat a wide field because of the characteristic spread of the tumor and the poorly localized, diffuse nature of the pain.

This treatment is usually well tolerated. Nausea and vomiting may occur, especially if the diaphragm is included in the field and a significant amount of liver or stomach is irradiated. Treating a large volume of the lung to this dose is not really a problem even though it is higher than lung tolerance, because few patients survive long enough to get pneumonitis and anyway, if the tumor is widespread, the lung is effectively splinted and non-functional.

Palliative radiotherapy can also be useful in treating patients with troublesome masses growing through the chest wall especially down the tracks of biopsy needles and chest drains. These lumps can be painful, car fumigate and bleed, or when large enough can be physically awkward for the patient usually a direct field to cover the mass can be used, but sometimes a pair of opposed glancing fields may be needed for a very large mass. A small area in an unfit patient could be a adequately treated with a single fraction of 10-15Gy, but higher doses such as 30Gy in 10 fractions or 40Gy in 15 fractions may be moiré appropriate if a large volume is treated or a more durable response is needed in a fitter patient.

Radiotherapy can also be used to prevent tumor seeding down the needle tracks. This occurs in about a third of patients who have had needle biopsies or repeated pleural drainage and for some it can be unpleasant and troublesome. A dose of 21 Gy in three daily fractions using orthovoltage X-rays or electrons and covering the area of the needle track of biopsy site may reduce the incidence of this problem.



Chemotherapy of Mesothelioma

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