The current treatment options for pleural mesothelioma include surgery, radiotherapy and chemotherapy.2 To determine the most appropriate treatment, cancers are ‘staged’ to establish how far the cancer has advanced in the body.5 The most practical and commonly used system is the ‘tumour-node-metastasis system’ (TNM) developed by the International Mesothelioma Interest Group.4 This system is used to give each case of pleural mesothelioma a score according to:11
The extent to which the surrounding tissue has been attacked (T)
The extent of lymph nodes involved (N)
The extent to which the cancer has spread to other organs in the body (M)
Depending on the above scores, the cancer is graded 0, I, II, III or IV to determine the most appropriate treatment option.11
Surgery may be used to remove the tumour or pleural fluid in the lung to relieve pain and other symptoms.10 The type of surgery chosen will depend on the stage of cancer, the cardiopulmonary reserve4 (the interdependence of the heart, lungs and O2 - carrying capacity of a patient) and the planned adjuvant therapy.10 Surgery is mostly used in combination with radiotherapy, chemotherapy and/or immunotherapy.4
Radiotherapy uses high-energy rays (such as X-rays) or particles to destroy cancer cells and shrink tumours. It can be used before surgery (to shrink the size of the tumour), during surgery (to directly target the tumour without passing through the skin) and after surgery (to kill any cancer cells that remain).7 For patients with pleural mesothelioma, radiotherapy is mainly used as an adjuvant treatment to relieve symptoms.4
Most pleural mesothelioma patients are candidates for chemotherapy, which is used to kill the tumour cells,10 and can be used in a combination of ways:11
Palliative chemotherapy to shrink tumours, alleviate symptoms and prolong life when surgery is not an option (often when pleural mesothelioma is diagnosed in an advanced stage)
Neoadjuvant chemotherapy to shrink a tumour before surgery or radiotherapy so it can be removed with fewer complications
Adjuvant chemotherapy to kill cancer cells that may remain following surgery
Research is also being undertaken to determine the long-term safety and effectiveness of targeted therapy and immunotherapy for the treatment of pleural mesothelioma; there are currently no targeted therapies or immunotherapies approved to treat this cancer.
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