Treatment for pleural mesothelioma


 Treatment for pleural mesothelioma

(Last Update : 24 November 2020)

  1. Chemotherapy for pleural mesothelioma
  2. Radiation therapy for pleural mesothelioma
  3. Trimodality therapy for pleural mesothelioma

Chemotherapy for pleural mesothelioma

Chemotherapy uses drugs to kill or slow the growth of cancer cells while causing the least possible damage to healthy cells. The main chemotherapy drugs for pleural mesothelioma are pemetrexed in combination with cisplatin or carboplatin. Research shows this combination can improve quality of life and increase survival by a few months more than using a single drug. The goals of chemotherapy are not only to increase length of life but also to shrink the cancer, reduce symptoms and improve quality of life. However, chemotherapy doesn’t work for some people.

Having chemotherapy for pleural mesothelioma

Chemotherapy is usually administered into a vein through a drip (intravenously). The drugs travel through the bloodstream and reach the entire body. This is known as systemic chemotherapy. You will usually have chemotherapy during day visits to your hospital or treatment centre. Each session may last for several hours followed by a rest period of several weeks. Together, the session and rest period are called a cycle. You will probably have up to six cycles. However, the length and timing of the treatment and rest days of each cycle may vary.

Side effects of chemotherapy 

Most chemotherapy drugs cause side effects. Side effects depend on the type and dose of chemotherapy drugs. Your specialist may prescribe vitamin B12 injections and low-dose folic acid, which have been shown to reduce the side effects of pemetrexed and cisplatin chemotherapy. You will also be given medicines (such as anti-nausea medicine) to help control any side effects that are likely to occur. If side effects become too difficult to manage, your oncologist can adjust the dose or type of chemotherapy.

Common side effects of chemotherapy include: 

  • tiredness and feeling weak (fatigue) 
  • nausea and/or vomiting 
  • bowel problems (diarrhoea or constipation caused by anti-nausea drugs) 
  • sore or dry mouth, or small ulcers in the mouth 
  • taste changes and/or loss of appetite 
  • increased risk of anaemia (low level of red blood cells) 
  • reduced kidney function 
  • skin rash 
  • numb or tingling hands or feet (peripheral neuropathy) 
  • ringing in the ears (tinnitus) or hearing loss 
  • red and itchy eyes (conjunctivitis).

Chemotherapy weakens the immune system by lowering the level of white blood cells, making it harder for your body to fight infections. If you have a temperature over 38 C, contact your doctor immediately or go to your nearest hospital emergency department. While hair loss and scalp problems are rare with chemotherapy for mesothelioma, hair may thin. Some people have trouble thinking clearly or experience short-term memory loss after chemotherapy, but this usually improves once treatment ends.

Radiation therapy for pleural mesothelioma

Also known as radiotherapy, radiation therapy is the use of targeted radiation to kill or damage cancer cells so they cannot grow, multiply or spread. Radiation therapy may be used at different stages of pleural mesothelioma treatment and in different ways:

  • as palliative treatment to relieve pain or other symptoms caused by tumours and improve quality of life 
  • after chemotherapy and surgery (adjuvant radiation therapy) to help kill any remaining cancer cells.

Having radiation therapy – Treatment is carefully planned to destroy as many cancer cells as possible while causing the least harm to your normal tissue. The initial appointment to map out the treatment (simulation) may take a few hours. You will have CT scans of the affected area, and your skin may be marked with a special ink. This makes sure that the radiation is directed at the same place on your body every time you receive radiation therapy. 

Although the ink is permanent, the mark is only the size of a freckle. Radiation therapy is usually given every day Monday to Friday as an outpatient treatment. A session usually lasts about 20 minutes because the radiation therapists have to set up the equipment and position you, but the treatment itself takes only a few minutes. The length of the treatment course will vary depending on why you’re having radiation therapy – it might involve 1–10 sessions for up to two weeks for palliative treatment, or longer if radiation therapy is combined with other treatments with the aim of long-term control. Radiation therapy doesn’t hurt and you aren’t radioactive afterwards. 

Side effects of radiation therapy – Radiation therapy may cause various side effects during treatment or shortly afterwards, but most side effects go away after the treatment stops. Your doctors and nurses will tell you what side effects to expect and how to manage them. The side effects of radiation therapy vary depending on the area of the body treated, but can include fatigue; peeling, cracked skin that looks red or sunburnt and may be uncomfortable; painful swallowing; or loss of hair in the treatment area.

Radiation therapy to the chest area can cause difficulty swallowing and symptoms of reflux for a few days or weeks, sometimes leading to weight loss. If high doses of radiation therapy are given to the chest area, it may cause permanent changes (fibrosis) in the lung tissue.

Trimodality therapy for pleural mesothelioma

Having a combination of chemotherapy, radical surgery and radical radiation therapy to treat mesothelioma is known as trimodality therapy. The aim of having the three types of treatment is to remove as much pleural mesothelioma as possible, and stop any remaining mesothelioma cells from growing or spreading. The most effective combination will depend on your situation. Trimodality therapy is an intensive treatment. 

Despite reduced lung capacity afterwards, some people continue to live independently. Although some studies show promising results, the benefits of trimodality therapy for pleural mesothelioma are not yet clear. There has not yet been an evidence-based trial comparing the results of trimodality therapy to less intensive treatment. Not all mesothelioma specialists recommend trimodality therapy, and it’s available only in a few specialist centres.

Treatment for pleural mesothelioma

Reference Sources:

  1. Understanding Pleural Mesothelioma  edition August 2019. © Cancer Council Australia 2019. ISBN 978 1 925651 63 8. (LINK)

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