Since most mesotheliomas come from the pleura, there has been more experience treating pleural mesothelioma than any other kind.
Stage 1 mesotheliomas confined locally to one side of the chest can be treated surgically with an extrapleural pneumonectomy (EPP). This is considered as possibly curative surgery. It can only be done at medical centers with experience doing these surgeries. The patient must be in overall good health. He or she must have good lung function. It is also usually done only for the epithelioid type of mesothelioma.
In an EPP, in order to remove the cancer and the tissues around it, the entire lung on the side of the tumor is removed, along with its coverings (the pleura), and all the pleura inside the same side of the chest, including the coverings of the heart and diaphragm on that side, which must then be repaired. The surgery is done through an open chest incision, and necessitates a two week stay in the hospital. It takes at least six to eight weeks to recover from the surgery. About a quarter of the people who have this operation have complications, and six or seven out of 100 will die during or after the surgery. However, when it is done in combination with chemotherapy or radiation therapy, it prolongs the life of the patient. The patients with mesothelioma that have lived the longest after being diagnosed had this treatment.
Patients with a more advanced stage who cannot tolerate EPP can have a pleurectomy and decortication. This involves removing the mesothelioma and involved pleura as well as any involved lung tissue. Chemotherapy or radiation therapy may be used after this surgery.
Patients can have palliative surgical procedures. They can have fluid removed from the pleural space, the space between the two layers of pleura in the chest, the parietal pleura that lines the chest wall and the visceral pleura that covers the lungs. This is called a thoracocentesis. A tube can be placed permanently in the space if fluid continues to re-accumulate. Or the area can be sealed by putting an irritating agent into the space.
Patients with stage 1 mesothelioma who are not surgical candidates, as well as patient with stage 2 and 3 will often get the two drug regimen of Alimta and cisplatin. This chemotherapy regimen involves a 21 day cycle. The drugs are given on day one by intravenous infusion, and this is repeated 21 days later. Vitamin B12 and folic acid must be taken with these to decrease side effects. Other regimens are being studied. Patients with stage 4 mesothelioma or patients with earlier stages who want to take part are encouraged to join clinical trials of new chemotherapeutic regimens. There are also trials using radiation therapy and other treatment modalities.