Surgery for mesothelioma treatment is a valuable option for patients because it often improves results in mesothelioma survival. Penn Medicine's mesothelioma surgery program in Philadelphia is unique. Few surgeons have the same level of experience in caring for pleural mesothelioma patients as do the thoracic surgeons at Penn. As the cornerstone of their approach to care, Penn thoracic surgeons collaborate closely with their colleagues in radiation and medical oncology to develop individualized treatment plans for patients with mesothelioma.
Mesothelioma treatment plans depend largely upon the location and stage of the tumor as well as the patients' overall health. In all cases, Penn's specialists strive for the safest and least invasive treatment options to preserve quality of life.
Surgery for Mesothelioma Treatment at Penn
The following surgical treatments for mesothelioma are offered at Penn Medicine in Philadelphia:
Extrapleural Pneumonectomy for Mesothelioma
In this surgery, the surgeon removes the lung, pericardium (membrane covering the heart), part of the diaphragm (muscle between the lungs and abdomen), and part of the parietal pleura (membrane lining the chest) to treat malignant mesothelioma.
Indwelling Pleural Catheter (IPC) for Mesothelioma
Patients with recurrent pleural effusion are sometimes treated with an indwelling pleural catheter. The device, inserted into the pleural space by Penn surgeons, removes excess fluid from the chest cavity and relieves symptoms associated with pleural effusion while allowing patients to remain at home.
Lung-sparing Radical Pleurectomy or Peritonectomy for Mesothelioma
Patients with mesothelioma may undergo a pleurectomy (removal of the lining around the lungs) or peritonectomy (removal of the membrane that lines the cavity of the abdomen) to remove diseased tissue. Penn surgeons combine this procedure with photodynamic therapy and are achieving promising results.
Minimally Invasive – Video-Assisted Thoracoscopic Surgery (VATS) for Mesothelioma
This minimally invasive technique diagnoses and treats problems in the chest including mesothelioma. A tiny camera called a thoracoscope and surgical instruments are inserted in the chest through small incisions, and the thoracoscope transmits images to a video monitor, guiding the surgeon in performing the procedure. VATS can be used to perform a biopsy, to remove tumors or remove an entire lobe from the lung.
Peritoneal Cytoreductive Surgery for Mesothelioma
In cytoreductive surgery, sometimes called "debulking" surgery, the surgeon removes as much of a tumor as possible. It is commonly combined with radiation therapy or chemotherapy.
Pleural Sclerosis and Fibrinolytics for Mesothelioma
Pleural sclerosis is used to obliterate the pleural space in order to prevent the recurrence of a spontaneous pneumothorax or the reaccumulation of a pleural effusion. Many different agents, ranging from antibiotics to talc are used to eliminate the space in which air or fluid can accumulate.
Therapeutic Thoracentesis for Mesothelioma
This simple procedure drains the fluid and relieves the symptoms of pleural effusion. It may also be used as a diagnostic test to look for causes of a pleural effusion. During therapeutic thoracentesis, physicians insert a needle into the pleural space to remove the fluid, relieving the pressure on the lungs to make the patient's breathing easier.
Thoracotomy for Mesothelioma
In a thoracotomy, surgeons make an incision between the ribs on one side of the chest to remove all or part of a lung, avoiding the heart and spinal cord.
Other mesothelioma treatments such as chemotherapy or radiation therapy are recommended to follow surgery or are prescribed in combination with surgery. These additional treatments for mesothelioma help ensure the cancer is removed as much as possible.
Radiation therapy precisely targets and attacks diseased tissue to slow or stop tumor growth. Radiation therapy for mesothelioma is an integral component of many mesothelioma treatment plans developed by physicians at Penn Medicine.
Mesothelioma can be treated with radiation therapy in different ways. Often, it is a tool to remove cancer that could not be completely removed during surgery. Radiation therapy can also be used to relieve symptoms of mesothelioma such as shortness of breath, pain, bleeding and difficulty swallowing.
The mesothelioma program at Penn offers patients a full complement of radiation treatments including new cancer treatments such as proton therapy — a powerful tool available at only a few cancer centers in the nation.
Radiation Therapy for Mesothelioma Treatment at Penn
The following radiation therapy treatments for mesothelioma are offered at Penn Medicine:
Brachytherapy for Mesothelioma
Brachytherapy involves placing small, radioactive implants, such as metal pellets, seeds, ribbons, wires, needles, capsules, or tubes in small, sealed holders inside the body. This is done in a hospital operating room and requires imaging technology (such as X-ray or MRI) to determine the exact location for the radiation to be placed to most effectively treat the cancer. Implants may be left in the body for only a short time, or permanently.
The advantage of brachytherapy is that it delivers a high dose of radiation to a smaller area than may be possible with external radiation treatment, which is delivered by machines located outside the body.
Intensity-modulated Radiation Therapy (IMRT) for Mesothelioma
IMRT is a form of radiation therapy administered by a linear accelerator — a computer-controlled device that delivers precise doses of radiation to tumors or specific areas within the tumors. Because IMRT uses 3-D computed tomography (CT) images and computerized dose calculations, it can conform, or modulate, the radiation beam more precisely to the shape of the tumor. This helps ensure that exposure to healthy surrounding tissue is minimized.
Photodynamic Therapy (PDT) for Mesothelioma
Penn was the first health system in the Philadelphia region to use photodynamic therapy to treat pleural cancers. Also known as photoradiation therapy, phototherapy, or photochemotherapy, PDT brings together light-sensitive medication (photosensitizer) and low-level beams of light to destroy cancer cells.
Proton Therapy for Mesothelioma
Penn Medicine's Roberts Proton Therapy Center is the largest and most sophisticated facility in the world for this advanced form of radiation treatment. Proton therapy is external beam radiotherapy in which protons are directed at a tumor. The radiation dose that is given through protons is very precise, and limits the exposure of normal tissues. This allows the radiation dose delivered to the tumor to be increased beyond conventional radiation. The result is a better chance for curing cancer with fewer harmful side effects.
Proton therapy, like all forms of radiation therapy, works by aiming the energized particles — in this case protons — onto the target tumor. The particles damage the DNA of cells, ultimately causing their death. Unlike X-rays, protons can be manipulated to release most of their energy only when they reach their target. With more energy reaching the cancerous cells, more damage is administered by each burst of radiation.
Volumetric-modulated Arc Therapy (VMAT) for Mesothelioma
VMAT radiation beams sweep in uninterrupted arc(s) around the patient, speeding treatment delivery and reducing treatment time. Imaging increases the precision and allows physicians to visualize the tumor target at the time of treatment and to guide therapy that both maximizes the radiation dose to the target and minimizes exposure to surrounding healthy tissues.
Penn Medicine was the first health system in the Philadelphia area to begin researching the use of Photodynamic Therapy to treat mesothelioma patients. Also known as photoradiation therapy, phototherapy or photochemotherapy, photodynamic therapy is based on a discovery that revealed that when light is exposed to certain chemicals at a particular frequency, it can kill single cell organisms. When used as a mesothelioma treatment, light-sensitive medications in combination with low-level beams of light destroy cancerous cells.
Photodynamic Therapy in Combination with Surgery
Because pleural mesothelioma occurs in several places in the lining of the lung simultaneously, surgery can be an ineffective treatment when used in isolation. However, when photodynamic therapy is used during surgery, it actually increases its effectiveness.
How Does Photodynamic Therapy Work?
Photodynamic therapy is a multi-step treatment process.
First, the photosensitizer medication is injected into the bloodstream of a patient. The drug typically takes a few days to be absorbed by the body. The drug gets absorbed by cells throughout the body, but stays in cancer cells longer than normal cells.
Then, when ready, the physician directs a laser light source at the cancer cells. The light causes the drug to react with oxygen to form a chemical that kills the cancer cells. The amount of time that the laser is applied will vary from patient to patient.
Photodynamic therapy can also work by destroying the blood vessels that feed the tumor.
Photodynamic therapy is only affective in areas that the light can actually reach. It works as a treatment for mesothelioma because mesothelioma is a cancer that affects the lining of the lung. During the surgery, the light is applied to the pleural space, or area surrounding the lungs.
Led by Associate Professor of Surgery, Joseph Friedberg, MD, Penn Medicine's researchers continue to learn ways to improve photodynamic therapy's effectiveness in fighting cancer. New cancer treatments may involve combining photodynamic therapy with gene therapy or with tumor vaccines to stimulate the immune system to fight cancer.
Chemotherapy for mesothelioma may be used alone, or in combination with other treatments for mesothelioma.
Chemotherapy for Mesothelioma Treatment
Penn Medicine has led the way in new cancer treatments that use chemotherapy to treat mesothelioma for decades. Patients benefit from a unique group of physicians and nurses who have unmatched experience and highly specialized training in mesothelioma treatment. As a result patients can live better, longer lives.
How Does Chemotherapy Treat Mesothelioma?
Chemotherapy may be administered via a pill or ingested liquid, or intravenously (through an IV). For most mesothelioma patients, chemotherapy is given through an IV.
Chemotherapy uses medicines that stop the growth of cancer cells, either by killing the cells or by preventing them from dividing. The drugs enter the bloodstream and can reach cancer cells throughout the body.
Multiple drugs that attack cancer in different ways can be combined to increase their effectiveness.
Chemotherapy Approaches for Mesothelioma
Chemotherapy is used in several ways. It may be the primary mesothelioma treatment, be used in combination with other treatments or act as a supporting treatment before and/or after surgery. For cancers that cannot be removed surgically, chemotherapy may be the main treatment.
For mesotheliomas that can be treated with surgery, chemotherapy may be given before surgery to minimize the cancer and lower the risk of spread. This is called neoadjuvant therapy. In some cases patients who were once considered inoperable may become surgical candidates following administration of chemotherapy.
Adjuvant therapy treatment is chemotherapy given after surgery. Chemotherapy after surgery is often used in combination with other forms of cancer treatment to reduce the chance of recurrence. This approach may include chemotherapy, hormone therapy, targeted therapy, immunotherapy (biologic therapy) or vaccine therapy. It is often effective in killing any cancer cells that were left behind because they were too small to be seen. Adjuvant therapy may also help delay or prevent the mesothelioma cancer from growing back, improving the outcome.
Targeted therapy is another approach to medical treatment for mesothelioma. Medical oncologists sometimes use targeted therapies, such as drugs or other substances to block the growth and spread of cancer by interfering with specific molecules involved in tumor growth and progression.
The Penn Mesothelioma and Pleural Program is a center made up experts from different fields who are dedicated to uncovering new cancer treatments for cancer treatments for patients with pleural mesothelioma and other pleural diseases.
Improving Mesothelioma Survival with Innovation
In addition to offering the best treatments available today, through in-house and collaborative research, Penn Medicine develops the best new treatments for mesothelioma. Biological therapies, (also referred to as immunotherapy, biological response modifier therapy, or biotherapy) are among the most innovative mesothelioma treatments available in the world.
Biological therapy for mesothelioma is designed to use the body's immune system to actually fight cancerous cells so the body can heal itself. Penn's medical oncologists use biologic or synthetic agents to repair stimulate or enhance the immune system, triggering the body's natural defenses to eliminate the cancer cells.
Gene Therapy for Mesothelioma
Researchers at Penn are pioneering the use of two forms of gene therapy to treat mesothelioma. In the first approach, a new gene is placed in a modified cold virus and inserted into the tumor itself. This new gene makes a substance called interferon that causes the body to reject the tumor using its own immune system.
In the second approach, patients' own white blood cells are collected and modified to recognize the tumor. When injected back into the patient, they attack and kill the tumor.
Penn Medicine physicians determine the best treatment options for mesothelioma depending upon the stage of the cancer. Along with age, general health, and the location of the cancer, three primary staging systems are used to assess how far mesothelioma has spread. Four stages describe the progression of the disease, and treatments options may vary depending upon the stage of the cancer.
Stage I Mesothelioma Treatment
Mesothelioma is localized in this stage and surgery is most commonly recommended to remove the tumor and affected tissue. A pleurectomy or extrapleural pneumonectomy are procedures that remove the tumor from the lung and nearby tissue. An assessment will be made to determine if chemotherapy or radiation treatment is necessary. Clinical trials may also be considered in this stage.
Stage II Mesothelioma Treatment
Surgery may also be performed in Stage II to remove as much of the tumor as possible. However, because the cancer has spread, surgery may be performed to relieve symptoms as opposed to curing the disease. Chemotherapy and radiation therapy are the most common treatments recommended. A variety of alternative treatments may be used to slow the progression of the disease and help manage the pain and stress associated with conventional treatments.
Stage III Mesothelioma Treatment
Treatment options recommended for Stage III typically focus on relieving pain, prolonging life, and improving the quality of life. Clinical trials may be beneficial in aiding the quest to find a cure.
Stage 4 Mesothelioma Treatment
This is the most advanced stage of mesothelioma. Pain management and keeping the patient comfortable is the primary focus. At this advanced stage, therapies such as chemotherapy and radiation are not typically considered. Many families consider the supportive network offered through a local Hospice program. Medications are also available to treat pain and suffering.