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Early Postoperative Chemotherapy

picture of chemotherapy ivWhat is Early Postoperative Chemotherapy?

Early postoperative chemotherapy is used as a mesothelioma treatment by immediately initiating drug therapy after a surgical procedure, such as cytoreductive surgery (surgery to remove or reduce the size of a malignant mesothelioma tumor).  Generally speaking, postoperative chemotherapy is a type of systemic chemotherapy in which an anti-cancer agent is delivered in a solution via an intravenous drip (IV). 

With this procedure, the chemotherapy drugs pass through the bloodstream and travel all over the body, eventually reaching the affected site.  However, chemotherapy can also be delivered via “ports” or catheters to more specifically target areas of the body such as the peritoneum (soft tissue which lines the abdominal cavity).

Many times, early postoperative chemotherapy is used as a follow-up measure to perioperative chemotherapy treatments, in which the chemotherapy drugs are delivered during the surgical procedure.  It is typically delivered in 6 or more sessions and requires an outpatient visit to a hospital or dedicated chemotherapy facility.

How is Early Postoperative Chemotherapy Different?

Multiple studies have confirmed that the most effective mesothelioma treatment approach is multimodal, combining some form of surgery and one or more types of chemotherapy, often with radiation therapy to follow. 

For years doctors relied on traditional chemotherapy to treat mesothelioma and other forms of cancer.  This drug therapy usually begins after a 30-day healing period that follows any surgical procedure. 

However, doctors are now questioning the need to wait and many have come to the conclusion that doing so may actually endanger the patient’s life and health in addition to worsening the prognosis.

One of the “myths” restricting the use of early postoperative chemotherapy is that it would somehow interfere with the wound healing process.  However, numerous studies have confirmed that early postoperative chemotherapy shares the same risk profile as any other type of systematic chemotherapy. Indeed, an article published in Obstet Gynecol way back in 1992 confirmed that the adverse reaction rates, including death rates, remain the same regardless of when chemotherapy is initiated. 

What’s more, that same study cites multiple prior studies which confirm that delays in beginning postoperative chemotherapy have been linked to higher death rates and rates of mesothelioma recurrence. 

One of the possible reasons behind this is that while the body is healing, scar tissue forms which isolates cancer cells from the chemotherapy drugs.  These passed over cancer cells then take up residence in other parts of the body and cause further tumor growth.

For these reasons, most mesothelioma oncologists recommend either perioperative chemotherapy or early postoperative chemotherapy.

Benefits of Early Postoperative Chemotherapy

There are several benefits of early postoperative chemotherapy when compared to traditional methods of chemo.  These include:

  • Similar survival rates compared to other forms of treatment
  • Less chance of wound-site tumor growth
  • Decreased risk of metastasis
  • Decreased risk of cancer recurrence
  • Similar side effects when compared to traditional chemotherapy, however often less severe and fewer side effects if intraperitoneal chemotherapy was also delivered during surgery
  • Better prognosis compared to chemotherapy not initiated until after a 30-day waiting period

Many of these risks and benefits can vary greatly depending on the type of drugs being used in the chemotherapy cocktail.  Mesothelioma responds best to multi-drug solutions but the list of available chemotherapy drugs is extensive.  Though most chemotherapy solutions contain cisplatin, it is the job of a mesothelioma specialist or oncologist to discover the best combination for each individual patient. 

Side Effects of Early Postoperative Chemotherapy

The side effects of early postoperative chemotherapy do not vary greatly from the side effects of traditional chemotherapy.  Studies have confirmed that the treatment itself has little or no effect on the healing of the surgical wound itself.

These side effects include:

  • Nausea, vomiting, diarrhea, constipation
  • Weakness or fatigue
  • Reduced immune capacity (the inability to fight infection or illness)
  • Weight loss or gain
  • Fluid retention
  • Allergic reactions to the drugs themselves
  • Bleeding events including bruising and blood clot formation

Depending on the type of cancer and the type of chemotherapy drugs delivered, the rates and severity of these side effects can vary greatly as well.

Mesothelioma Patients Benefit from Early Postoperative Chemotherapy

Mesothelioma is one of the cancers that responds well to early postoperative chemotherapy.  This is because mesothelioma is a very aggressive disease.  It often metastasizes quickly and can spread to the lymph nodes and vital internal organs if unchecked. 

Often times, surgery increases the risk of metastasis.  By delivering chemotherapy immediately after surgery, doctors are able to turn the patient’s body into a hostile environment for these “cancer seeds” and prevent them from taking hold in other parts of the body.

In addition, malignant mesothelioma tumors are very difficult to differentiate from the healthy tissue that surrounds them.  They grow in soft tissue and membrane and can often be mistaken upon visual inspection.  Therefore, the probability that a surgical oncologist will miss at least a tiny portion of a tumor during a cytoreductive surgery is high.

By initiating chemotherapy immediately, doctors can combat any remaining pieces of the original tumor and arrests its growth or even shrink it.

However, each mesothelioma case is very specific and one patient may respond better to other forms of treatment.  There is no one-size-fits-all solution when combatting this deadly disease.  Consult with your medical team to decide which treatment is best for you.  To find out how your medical costs can be covered, contact one of our mesothelioma attorneys today at 415-332-4262 We have been helping patients and their families for over 30 years and have extensive experience in the field.