Trimodality therapy for pleural mesothelioma

Having a combination of chemotherapy, radical surgery and radical radiation therapy to treat mesothelioma is known as trimodality therapy.

Learn more about:

• Overview
• Who can have trimodality therapy
• The three parts of trimodality therapy

Overview

The aim of having the 3 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 how you respond to treatment.

Trimodality therapy is an intensive treatment available only in a few centres. Despite reduced lung capacity afterwards, some people continue to live independently. Studies are promising, but there are no results comparing trimodality therapy with less intensive treatment.

Who can have trimodality therapy

• with a small amount of pleural mesothelioma at an early stage (T1–T3)
• with an epithelioid type of pleural mesothelioma
• whose scans show a good response to chemotherapy before surgery and no signs of pleural mesothelioma progression
• with no signs of spread into the lymph nodes or any other disease on CT and/or FDG–PET scans
• who are able to live independently with one lung
• who are physically fit enough for surgery.

Your surgeon is the best person to work out if trimodality therapy may be suitable for you. Ask your surgeon or oncologist to explain the likely outcome for you. An EPP or PD is a major operation, and not everyone wants to go ahead after the risks and benefits are explained. Sometimes, even if someone seems suitable for intensive treatment, the doctor may adjust treatment if the mesothelioma doesn’t respond well to chemotherapy, is growing quickly or has spread, or if the person has become too tired or unwell.

The three parts of trimodality therapy

	1. Chemotherapy Several cycles of chemotherapy are given to shrink the tumour. A scan then checks the size of the tumour. If it has shrunk, you’ll have surgery in 4–6 weeks. If there is little or no response, you will not have radical surgery. Chemotherapy is usually given before surgery, but some people have chemotherapy after surgery.
	2. Radical surgery This is either an extrapleural pneumonectomy (EPP) or pleurectomy decortication (PD). An EPP removes the whole lung, a PD keeps the lung but removes the outer lining of the pleura (parietal pleura) and any visible tumours. Sometimes a smaller operation removes only part of the parietal pleura. Lymph nodes in the centre of the chest that drain the lung are also removed. You’ll stay in hospital for 10–14 days, or longer if complications occur. After 6–8 weeks you’ll be able to start radiation therapy.
	3. Radical radiation therapy Radiation therapy aims to kill any remaining mesothelioma and is delivered using intensity- modulated radiation therapy (IMRT). This type of radiation therapy can be accurately shaped around the chest cavity, so higher doses can be delivered directly to the tumour cells while minimising the damage to other organs in the chest and abdomen. IMRT is often given after surgery, but may be given before surgery. How long you need radiation therapy will depend on your circumstances. Radiation therapy may cause side effects, but most improve after treatment.

After I was diagnosed, I had chemotherapy for 10 months. Then I had my right lung removed. This surgery was followed by 30 treatments of radiation therapy.

SERAFINA

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