The treatment of mesothelioma is done using various options all of which aim at the removing or suppressing of the malignant mesotheloima cells. Modern improvements have occurred in the treatment of the disease. These have mainly been in prognosis into newer chemotherapies coupled by multimodality treatments. It is important to note that treatment of the malignant cells at an early stage is essential since this enhances better prognosis. However, cure for this cancer is usually rare. The malignant cells have certain clinical behaviors which affects the malignancy. These factors range from the continuous mesothelial surface which favors local metastasis through exfoliated cells, invasion of other cells hence the random growth within the underlying tissues and the period between exposure to asbestos and disease development. There are three important factors to be considered in the disease prognosis which include:the age of the patient, health status,and the histological subtype. The epithelioid responds better to treatment and has a higher survival rate as opposed to the sarcomatoid histology.

The treatment options present include:

Surgery

This is mainly used where mesothelial cancerous cells are present. They may lead to the formation of growth which are surgically removed through excision. It is not effective if used alone but can be combined with other procedures for example chemotherapy in order to improve the median survival rate. The most common procedure in operation is pleurectomy which involves the removal of the chest's lining. Extrapleural pneumonectomy is the lesser common where the lungs, chest lining, pericardium and the hemi-diaphragm are removed.

Radiation

It is given before the operation as a consolidative treatment. This is often to patients who can withstand radical surgery and have localized disease. Radiation therapy is conducted hand to hand with chemotherapy and when done after surgery may lead to an extended life expectancy in different patients of up to 5 years. It is commonly applied to the chest drain insertion area to restrict track tumor growth along the chest wall. This is a curative approach an dis now commonly used in treatment.

Immunotherapy

This treatment option has yielded mixed results in the cure of mesothelioma. Some of the cells are susceptible to in vitro lysis of LAK cells but patients under this treatment have had massive side effects. Therapy through the use of interferon alpha are more encouraging since it has led to 50% tumor mass reduction in 20% of the patients with few side effects.

Heated Intraoperative Intraperitoneal Chemotherapy

Here, the surgeon removes much of the tumor and then a chemotherapy agent is directly applied. This agent is heated at temperatures of 40 and 80 0c in the abdomen and is perfused for between 1 and 2 hours then drained. Heating increases the drug penetration into tissues and also destroys the malignant cells more than the normal cells. This procedure allows one to administer high drug concentrations into the affected surfaces.

Multimodality Therapy

This technique was developed on the need to reduce the bulk of the tumor and hence improve survival of the patient. Both extrapleural pneumonectomy and pleurectomy are used and the indications of their use are unique. Size of the tumor influences the choice of operation. In the former, the underlying lung is spared and is performed on patients within the early stage. Here the intention are to remove the whole tumor as opposed to extrapleural pneumonectomy which is more extensive. It is performed on patients whose tumors are more developed and can not tolerate pneumonectomy.

By Dave Berger