Standard of Care
Malignant mesothelioma, while an aggressive disease, is manageable. Mesothelioma can be treated by surgery, chemotherapy, radiation therapy, photodynamic therapy (a “targeted” treatment pioneered at Roswell Park) and other new therapies. Treatment options for more advanced disease focus on preserving quality of life.
Since Roswell Park’s surgical program emphasizes lung-sparing surgery, pleurectomy decortication is the preferred surgical treatment for mesothelioma. Patients who undergo pleurectomy decortication face an extended recovery period, but the procedure has been shown to extend survival time.
Chemotherapy, which uses drugs to kill cancer cells, may be used both before and after surgery, as well as a treatment for those patients who are not able to tolerate surgery. For patients with advanced disease, chemotherapy is used as a palliative treatment to reduce pain, maintain lung function and preserve quality of life.
Because the tumor may be near the heart and lungs, it’s challenging to provide the kind of high-dose, intensive therapy needed to shrink the tumor. However, intensity-modulated radiotherapy (IMRT), which is available at only a few centers nationwide, including Roswell Park, can more accurately target cancer cells and avoid damaging healthy tissue.
Photodynamic therapy (PDT), developed in the late 1970s by chemist Thomas Dougherty, PhD, of Roswell Park, is a targeted anticancer treatment — one that kills tumor cells without permanently damaging surrounding tissue. The treatment involves the administration of a nontoxic drug that settles in tumor cells, followed by the application of laser light to the tumor, thereby activating the drug and killing the cancer. At Roswell Park, PDT is used in combination with surgery to treat select types of cancer, including localized mesothelioma. The addition of PDT to conventional therapy has improved survival rates and quality of life for patients with early-stage disease.
Cytoreductive Surgery /Hyperthermic Intraperitoneal Chemoperfusion (CS/HIPEC)
In 2002, John Kane III, MD, FACS, established the first cytoreduction/hyperthermic intraperitoneal chemoperfusion (HIPEC) program at Roswell Park. Today, cytoreductive surgery/HIPEC is routinely used as a treatment for peritoneal mesothelioma, once considered a fatal disease with patients living, on average, about one year.
After surgery removes all visible tumors, heated chemotherapy drugs are circulated throughout the abdominal wall. Because the drugs are restricted to the abdomen, very high doses can be used to kill cancer cells more effectively, while reducing the drugs’ side effects on other healthy tissue and organs.
To date, over 100 patients have received this treatment. In select patients, the results can be highly effective, with about 70 percent of patients alive at five years. Roswell Park is the only center in New York State to offer this cutting-edge therapy; patients come here from across the USA and Canada.
Roswell Park’s lung surgeons have recently begun using Intrapleural heated chemotherapy (HITOC), a procedure very similar to HIPEC, for pleural mesotheliomas. In the operating room, immediately following lung-sparing pleurectomy/decortication, surgeons spray heated chemotherapy drugs directly into the thoracic cavity before closing up the chest.
Investigational Therapies (Clinical Trials)
Clinical research studies are available to patients with all stages of mesothelioma. Our dedication to this research is a hallmark of our mission to understand, prevent and cure cancer. View a list of available clinical research studies for mesothelioma and lung cancer at Roswell Park or call 1-877-ASK-RPCI (1-877-275-7724). A list of clinical research studies can also be found at the National Cancer Institute website.
Recurrent Malignant Mesothelioma
Check the National Cancer Institute website for cancer clinical trials that are currently enrolling patients with recurrent malignant mesothelioma.