Mesothelioma treatment depends on the stage of the disease is, and you can tell that there is no standard treatments because of the smallness of their impact. The following therapies are currently used:
Surgery
Surgery with curative intent is, in theory, the best choice for the treatment of mesothelioma, however, complete resection (with large and negative margins) is rarely achieved. Less than 25% of the operated patients remain alive at 5 years.
We have the following options:
Extrapleural pneumonectomy: is bloc resection of the parietal pleura and visceral, along with the lung infiltrated by the tumor, mediastinal lymph nodes, diaphragm and pericardium. All this is reconstructed meshes.
It is a very complicated technique that is not done in all centers and having a high perioperative morbidity and mortality (in highly selected cases and expert hands is 4%). It has an average survival between 9 and 19 months and a survival rate at two years between 9 and 37%.
Pleurectomy (decortication): it involves resection of the parietal pleura, including the portion of the mediastinum, pericardium and diaphragm and part of the visceral pleura.
This technique is less aggressive than before and, above all, more functional for the patient; intervention mortality ranges between 1.5% and 5%, what happens is that with this technique in 80% of cases remains viable tumor.
This technique does not prolong survival, but better controls recurrent pleural effusions, more effectively than talc pleurodesis (paste the parietal pleura visceral introducing talc between the two pleural "leaves"). The median survival time is between 9 and 20 months
VATS (VATS) and pleurodesis: is considered the symptomatic treatment of choice.
Radiotherapy
Although mesothelioma is a radiosensitive tumor, radiotherapy indications are limited due to the proximity to the heart, esophagus, liver and spinal cord (more radiosensitive structures).
It can be used in
1. Prophylactic radiotherapy in the biopsy or puncture, to prevent tumor spread.
2. Palliative radiotherapy relieves pain in 50% of patients without influencing survival.
3. Adjuvant radiotherapy (complementary) with or without chemotherapy after surgery (although no studies showing benefit).
Chemotherapy
Approximately 85-90% of patients are presented as mesotheliomas (locally advanced or metastatic) unresectable disease, so the intention of the treatment is palliative. We have seen this scenario for surgery and radiotherapy.
Chemotherapy obtained between 10 and 20% response in monotherapy. Employees agents are platinum (cis or carboplatin), anthracyclines (adriamycin) and antimetabolites (pemetrexed). In polychemotherapy schemes, the answers are higher (up to 48%).
The most active scheme is cisplatin-pemetrexed, so it can be considered the standard treatment for unresectable disease. Another drug to keep in mind in combination with platinum (even with oxaliplatin) is the raltitrexed.
The new antidiana agents (anti-angiogenic tyrosine kinase inhibitors or) have not shown, for now, its usefulness.
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