Traditional Treatments:
Mesothelioma is an uncommon cancer and, to date, a cure remains elusive. Since mesothelioma is such a rare form of cancer, it is rarely seen in most medical centers. Members of the Brigham and Women's Hospital Thoracic Surgery Division have extensive experience in treating patients with mesothelioma. It is important that patients with mesothelioma are treated at centers with expertise in MPM to maximize expertise and allow innovative treatment combinations to be implemented with the greatest chance of success.
Specialists at the International Mesothelioma Program (IMP) have more than 20 years of experience in treating mesothelioma and offer the full spectrum of conventional and novel therapies, personalized to each individual patient and cancer, in a caring and compassionate environment. Treatment includes precise diagnosis, state-of-the-art multimodality therapy, and supportive care for patients and their families.
In addition to providing state-of-the-art therapies, IMP clinicians also are committed to providing personalized care – that is, tailoring treatment strategies to address the individual disease of each patient. Two new tests will help clinicians tailor therapy for their patients. The first, known as the EDR (Extreme Drug Resistance) assay, provides information on whether an individual patient’s tumor is likely to be resistant to standard mesothelioma chemotherapeutic agents and allows doctors to adjust treatment accordingly. The second test is a research breakthrough of the IMP Thoracic Surgery Oncology Laboratory. This four gene ration test predicts whether an individualpatientis likely to benefit from standard trimodalitymesothelioma therapy based on ratio of gene expression. When combined with other patient specific information, the test allows surgeons to predict with a high degree of certainty which patient will respond favorably to surgery and which should consider for more aggressive experimental therapy. Our researchers hope to make this test available to patients in the near future.
Diagnosis
The foundation for mesothelioma treatment is precise diagnosis. The disease can be challenging to diagnose, and IMP pathologists bring a wealth of experience to the task. The evaluation process includes medical history, any history of asbestos exposure, a careful physical examination, lung function tests, and a variety of imaging techniques. If any of these tests indicates the presence of mesothelioma, a biopsy is taken to confirm the diagnosis.
Once mesothelioma is confirmed, the next step is to check for lymph node involvement to determine the extent of disease. The technique used is cervical mediastinoscopy, a surgical procedure that enables biopsy of lymph nodes from the central compartment of the chest cavity. Following diagnosis and staging, the treatment team develops personalized therapeutic strategies that may encompass surgery, chemotherapy, radiation, and palliative procedures, for every patient.
Clinical Care
There is no known cure for mesothelioma and there exists no universally accepted standard therapy.Options for therapy include surgery, chemotherapy, radiation therapyand combined approaches, utilizing multiple types of therapy. However combination approaches (named multimodality therapy) utilizing surgery, chemotherapy and radiationtreatments have shown promise in extending survival of some patients with early disease.
The goal of surgery is to remove all visible tumor. Maximal tumor removal is the primary contributor to extension of life. Surgical options include pleurectomy(P/DC), removal of the lining of the chest, or extrapleural pneumonectomy (EPP), removal of the affected lung along with the lining of the chest (pleura), portions of the covering of the heart (pericardium), and the diaphragm. Following surgery, additional treatments (adjuvant treatment) including radiation and/or chemotherapy are offered to enhance local and systemic control of disease.
Chemotherapy may be used to control cancer by killing tumor cells, slowing tumor growth, or inhibiting its spread (metastasis); to shrink tumors prior to other therapy such as surgery (neoadjuvant therapy); to destroy cancer cells that remain after another treatment (adjuvant therapy); or to relieve symptoms (palliative care).Chemotherapy drugs may be given as single agents, but often, two or more drugs are given simultaneously (combination therapy).
IMP clinician-scientists have pioneered a novel way to administer chemotherapy to improve the effectiveness of treatment. This strategy involves surgery to remove all visible disease, followed by perfusion of the chest cavity with a heated bath of the chemotherapy drug or drugs (intracavitary lavage). Heating enhances drug uptake and works synergistically with the cisplatin to increase tumor cell death. In addition, other drugs are administered to protect normal cells from the chemotherapy agents and reduce systemic side effects.
Mesothelioma Surgery and Staging
Chemotherapy
Adjuvant Therapy
Palliative Therapy
Radiation Therapy
Multimodality Therapy:
Send Feedback to: 
