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Well-Tolerated Multimodal Treatment for Mesothelioma

Malignant Mesothelioma is a very aggressive and hard to treat form of cancer caused by asbestos exposure. Traditional treatments for mesothelioma—including surgery, chemotherapy, and radiation treatments—are typically ineffective and can prolong lifespan for only a minimal amount. This has led scientists and researchers to try and find an optimum multimodal approach to treating mesothelioma that combines multiple traditional and innovative options.

A recent study published in the Journal of Thoracic Oncology reports that a multimodal approach utilizing pleurectomy/decortication (P/D), hyperthermic pleural lavage with povidone-iodine followed by adjuvant chemotherapy is not only well tolerated by patients but carries a lower death rate and longer life expectancy than some more traditional methods of attacking mesothelioma. 

The first part of the treatment is a rather invasive surgery called a pleurectomy/decortication (P/D). Essentially, surgeons remove the pleura—the soft tissue that surrounds the lungs. This is the tissue in which mesothelioma tumors form after asbestos fibers are inhaled. The treatment may seem aggressive but it is a less-invasive option to extra-pleural pneumonectomy (EPP) where doctors remove the entire lung, a portion of the diaphragm, and some of the membrane around the heart. 

On a side note: P/D by itself has been found to have fewer negative consequences in comparison to EEP and has been recommended by several mesothelioma doctors including Dr. Michael Weyant, thoracic surgeon and associate professor at the University of Colorado.

The second phase of this multimodal treatment is the use of povidone-iodine directly at the surgical site. This allows for medication to be delivered where it is needed rather than a general dispersal throughout the body. This type of therapy has become increasingly popular in recent years as it minimizes the negative side effects of treatment.
The third part of the treatment is standard systematic chemotherapy, which has been used to treat mesothelioma for years.
When the doctors examined the results of this multimodal approach, they were quite surprised to see just how well it worked. The thirty day death rate was zero with most patients living for up to 24 months after the treatment. This is a huge success considering that most malignant pleural mesothelioma patients will die within as little as 3 months. The longevity trend stayed steady over time with the one-year survival at 91.7%, and the 2-year rate at a respectable 61%.

While this type of combination treatment was able to increase the average lifespan of MPM patients, its low morbidity and mortality rates are what really impressed researchers. EPP carries with an extremely high mortality rate, both on the operating table and within the first 60 days after surgery.  P/D does not.

However, the researchers themselves were quick to point out that the sample size of this study was smaller than they would have liked. Still, as P/D increases in popularity, more data will be collected and scientists will have a better understanding of how to treat malignant pleural mesothelioma without completely removing organs and unnecessarily risking the patient’s life.