Mesothelioma has many treatment methods.With these methods you can get rid of mesothelioma disease.You will have a hard time and this may make you a little tired.
Other modalities of treatment, such as in cancer types; Surgery, radiotherapy, chemotherapy, immunotherapy, supportive therapy, and combinations of these treatments. However, the combination of choice of treatment and the ideal treatment remains rather unclear due to the absence of the staging system and the documentation of different criteria in each clinical treatment series. The final IMIG cycle aims to enable standardization and common evaluation of these treatment protocols.
Since malignant mesothelioma generally tends to retain an entire hemithorax, and therefore the planned radiotherapy is aimed at an entire hemithorax, the sensitivity of the structures such as esophagus, lung and spinal cord in the hemithorax to radiation must be limited. For this reason, usually the total dose given is 4500 cGy or less. Some chemotherapeutic agents, such as doxorubicin, may increase the efficacy of given radiotherapy and the toxicity of the locus (radiosensitization).
Radiotherapy is usually not administered as a primary treatment, either as an adjuvant surgical treatment, or as a symptomatic palliation in tumors that hold the chest wall or mediastinum. Surveillance provided for this purpose is relatively low at 17% for 2 years (32). In general, radiotherapy is a far crying cure for a malignant pleural mesothelioma and the tumor is among the radiotherapy-resistant tumors.
Given the Phase II study results of the chemotherapies administered, it can be seen that the response rates are between 15% and 40%. The reason for this discrepancy is the variability of patient selection criteria, the diversity in diagnostic criteria, and the lack of use of CT for evaluation in some studies. Combination use of chemotherapy agents has not been shown to be superior to single drug therapy. In a randomized phase II trial, the response to cisplatin + doxorubicin was reported to be 13% while the response to cisplatin + mitomycin was reported to be 28%, but no significant difference in survival was found between the two treatment regimens (33). With a newer treatment regimen, Byrne and colleagues found a 48% response to cisplatin and gemcitabine in 21 patients in a phase II trial (34). With new drugs that may be more effective, efforts are being made both for single use and for use before and after surgical treatment. Anti-angiogenic treatments are also in progress.
Interferons are substances known to be both anti-proliferative and facilitating differentiation in mesothelioma. In a study conducted, 8 of 89 patients given interferon-g had complete response, 9 had partial response, and the overall response rate was 20% (35). In stage I patients, the response rate was 45%.
IL-2 based immunotherapies are intensively researched immunotherapy protocols. The largest study in this regard has been conducted by Astoul and colleagues in a study reporting the use of intrapleural IL-2 in 22 patients (36). In this study, partial response in 11 patients and complete response in 1 case were found. 2-year survival was 58% and 3-year survival was 41%.
Limitations in radiotherapy and chemotherapy outcomes have made surgical treatment one of the main treatment steps. Surgery is divided into two parts: the surgical procedures performed with the aim of treatment and the surgical procedures performed with palliation purpose.
Palliative procedures include talc pleurodesis with pleural effusion, which can not be candidates for surgical treatment. Tracheotomy and partial pleurectomy can be performed in patients with pleural effusion who can not be evacuated with VATS. For patients with a relatively relatively major surgery for pleural effusion, pleuroperitoneal shunting (Denver) may be performed if dyspnea is caused by pleural effusion.
Therapeutic treatments are divided into extrapleural pneumonectomy, pleurectomy / decortication. Until recent studies, superiority of extrapleural pneumonectomy compared with decortication / pleurektomy was controversial. Because, for the first time, Butchart reported the results of extrapleural pneumonectomy, it was seen that mortality occurred at a rate as high as 30% in these cases (27). This proportion was reported as 15% in one study in 1991 (37). This rate decreased in the following years due to better preoperative pulmonary and cardiac examinations, better patient selection and resectability, and better postoperative patient care. Extrapleural pneumonectomy, diffusion capacity is very important because; The gas exchange capacity due to the interstitial fibrosis caused by the asbestos exposure of the lung, which is to remain after the operation, usually falls.Determining the amount of this decline preoperatively is an important step in preventing postoperative morbidity and mortality.