Combination of chemotherapy and radiation therapy
There are no large randomized clinical trials or randomized clinical data available for the use of chemotherapy in combination with radiation therapy in the treatment of malignant mesothelioma. Cisplatin and doxorubicin are active drugs in mesothelioma and also theoretically can can act as a radio-sensitizers to bring more local control of mesothelioma. Paclitaxel has also been used in the setting of chemoradiation as a radio-sensitizer.
Surgery followed by adjuvant therapy
Surgery is unable to remove all the tumor bulk in majority of patients with malignant mesothelioma. Adjuvant post-operative chemotherapy and radiation treatment are often given to patients who had debulking surgery. Alberts et al (Ref 1) in a series of 26 selected patients reported a median survival of 11 months after debulking surgery followed by chemotherapy and radiation. A non-randomized clinical trial from Helsinki University Central Hospital (Ref 2) reported a series of 100 patients and showed that the median survival time was increased from 8 to 12 months when chemotherapy and radiation therapy to the affected half of the chest wall was added to debulking surgery.
Pleurectomy, Intraoperative Brachytherapy, and post operative radiation therapy
Memorial Sloan-Kettering Cancer Center has studied this modality of therapy for malignant mesothelioma (Ref 3). This method consisted of pleurectomy, followed by instillation of permanent or temporary implantation of radioactive isotopes. Radioactive phosphorus is selectively instilled into the pleural cavity 5-7 days after the surgery. This is followed by external beam radiation therapy, starting about 4-6 weeks after surgery. They have reported a median survival of 21 months with this approach. Majority of these patients had recurrence at distant sites (54%) with or without local recurrence.
- Alberts AS, Falkson G, Goedhals L, et al. Malignant pleural mesothelioma: a disease unaffected by current therapeutic maneuvers. J Clin Oncol 1988;6:527.
- Mattson K, Holsti LR, Tammilehto L, et al. Multimodality treatment programs for malignant pleural mesothelioma using high-dose hemithorax irradiation. Int J Radiat Oncol Biol Phys 1992;24:643.
- Hilaris BS, Dattatreyudu NK, Wong E, et al. Pleurectomy and intraoperative brachytherapy and postoperative radiation in the management of malignant pleural mesothelioma. Int J Radiat Oncol Biol Phys 1984;10:325.