Intraoperative Chemotherapy and Radiation

What was initially a controversial approach to treatment, intraoperative chemotherapy and radiation has become more commonplace due to its life extending benefits. These treatments are applied directly to the location of a patient’s cancer while they are undergoing a surgical procedure. The purpose of intraoperative treatments is to kill any remaining microscopic mesothelioma cells after visible tumors are removed.

Dr. Paul Sugarbaker pioneered intraoperative chemotherapy, known as hyperthermic intraperitoneal therapy (HIPEC), for patients with a diagnosis of peritoneal mesothelioma.

Although there are still those in the medical community who are critical of the procedure, the success rates and survival rates are constantly improving. One study showed that those who had an operative cytoreductive surgery with HIPEC doubled their 2-year survival rate. Survivors like Alexis Kidd have this treatment to thank for their recovery.

Dr. Paul Sugarbaker’s brother, Dr. David Sugarbaker, has also used intraoperative chemotherapy in patients with pleural mesothelioma after having an extrapleural pneumonectomy. For those who opt for the alternative to the EPP, pleurectomy with decortication, intraoperative radiation is used to kill remaining cancer cells. Get connected with top specialists using our free Doctor Match program.

Combining Surgery With Traditional Cancer Treatment

Adjuvant chemotherapy is used to destroy mesothelioma cells that doctors were unable to remove with surgery alone. This type of multimodal chemotherapy treatment is also responsible for longer survival times in mesothelioma patients.

The idea behind neoadjuvant therapy is to shrink any tumors before attempting surgery. Therefore the chemotherapy is administered with the intention of having a future surgical procedure.

Chemotherapy and radiation therapy are the most well-known and traditional treatment methods for patients with all types of cancer. These traditional treatment methods haven’t always been the most effective for mesothelioma patients, but multimodal treatment methods are changing that.

It wasn’t long ago that chemotherapy didn’t have much effect for mesothelioma patients. However, the introduction of new chemotherapy drugs a little over a decade ago has given patients and families cause for hope. Furthering the cause for hope is the way chemotherapy is being administered in addition to surgical treatment.

Neoadjuvant and Adjuvant Chemotherapy

One of the best developments in treating mesothelioma with multiple modes of therapy is the use of neoadjuvant and adjuvant chemotherapy. Neoadjuvant chemotherapy is chemotherapy that is applied prior to surgery whereas adjuvant chemotherapy is administered post-surgery.
Neoadjuvant Therapy

A study in 2004 in 16 patients in varying stages of mesothelioma who had chemotherapy prior to an extrapleural pneumonectomy resulted in several patients living over 3 years, while the median survival for this group was just under 2 years from the date of the surgery.

Adjuvant Chemotherapy
As multimodal therapy is used in essentially all patients who undergo surgery, it is up to the mesothelioma specialist to decide whether neoadjuvant or adjuvant chemotherapy is more appropriate for the patient. However, adjuvant chemotherapy is often replaced with adjuvant radiation therapy, especially in patients who had a pleurectomy with decortication or patients undergoing a trimodality approach.

Mesothelioma Treatment Options

There are treatment options available for patients with all stages of mesothelioma and include surgery, chemotherapy, radiation and new clinical options.
Doctors offer three primary types of treatment to malignant mesothelioma patients: Surgery, chemotherapy and radiation. The types of treatment you receive depend on your diagnosis, the stage and type of your mesothelioma and your overall health.

If the cancer has not yet spread, a combination of radiation, surgery and chemotherapy likely will be offered to you. This combined approach to treatment is called multimodal therapy.

If the mesothelioma already has spread significantly, doctors typically recommend palliative treatments that can help alleviate pain, breathing problems and other cancer symptoms that lessen your quality of life. You are still likely to be offered radiation and chemotherapy, but probably not major surgery options.

Radiation therapy can soothe pain and correct breathing issues by shrinking tumors that press on your nerves, veins and airways. Chemotherapy also shrinks tumors, helping with chest pain and night sweats. Non-curative surgeries can remove tumors that cause troublesome symptoms, or drain fluid that builds up in the chest or abdomen.

You may also want to talk to your doctor about other treatment options beyond surgery, chemotherapy and radiation therapy. Experimental treatments exist, mostly in clinical trials, and sometimes they can make a huge difference.

Some patients also pursue alternative treatments like massage therapy, acupuncture or yoga. These can often be added to standard treatments like chemotherapy, so talk with your doctor about which therapies you'd like to explore.

What Are My Treatment Options?

There are several treatment options for patients with mesothelioma, from surgery to chemotherapy. These treatment options are not typically considered a cure for mesothelioma patients, although patients have reached remission in certain cases. These cases are typically situations where the disease was caught in the earliest stages and treated aggressively by a specialist.

Surgical options are available for both curative and pain-relief purposes for all types of mesothelioma. Recovery from surgery can last several weeks.

Chemotherapy is an effective and viable form of treatment viable for patients with all 4 stages of malignant mesothelioma.

Radiation therapy can be used before and after surgery to help shrink tumors and kill remaining cancer cells in a specific area of the body.

Mesothelioma Multimodal Treatment
Multimodal Treatment
Aggressive surgical treatments combined with chemotherapy and radiation have increased the life expectancy of many patients.

Mesothelioma Clinical Trials
Clinical Trials
Clinical trials offer patients access to emerging treatments such as immunotherapy treatments, gene therapy and photodynamic therapy.