There have been some very exciting recent developments we (the Thoracic Surgery team at Swedish Cancer Institute) are utilizing in the treatment of malignant pleural mesothelioma (MPM).
Over the past year we have offered some of our patients deemed appropriate for surgery a more streamlined approach to their overall care. Previously we have tried to offer chemotherapy, surgery, and radiation to all patients who were healthy and strong enough to undergo the three treatments, as mesothelioma is an aggressive cancer requiring aggressive treatment to optimize survival. This new approach still offers both surgery and radiation, but chemotherapy is given only to those found to have cancer in lymph nodes in the center of chest during surgery.
The advantages of this new treatment paradigm are numerous for our patients and their loved ones. Patients now receive radiation not over a month as previously occurred, but over the span of just five days. Both the five day and the month-long treatment are highly specialized, and we need our patients with MPM to stay in the area for that time as this type of radiation can’t be offered in any institution not highly experienced in mesothelioma treatment. Streamlining the radiation to five days has obvious advantages for both the patient and their family supporting them during their treatment in Seattle. There may be additional anti-cancer advantages as well, which we are discovering as patients treated with this protocol are experiencing survival better than anything we have ever seen for malignant pleural mesothelioma (as published in two reports in our thoracic surgical literature over the past year)!
Once the five day radiation treatment is complete, it is necessary to go to the operating room within seven to ten days to perform an extrapleural pneumonectomy (EPP) or removal of the cancer, all pleura, the lung, diaphragm and pericardial sac. The diaphragm and pericardial sac are reconstructed in the OR. Given the high dose radiation that is given, we can only offer these patients an EPP and not a pleurectomy/decortication. While we used to give chemotherapy to all patients who could undergo surgery, we now offer it only to those who have nodes positive in the middle of the chest found at surgery. This also saves the patient months of chemotherapy potentially while still achieving survival better than anything previously published.
As patients with MPM travel from far distances to come see us, this has made the whole experience easier to undergo in all respects. Unfortunately, not all patients are candidates for an operation and so not all MPM patients can be offered this treatment. However, if a patient is strong enough for surgery, this is our preferred approach as the published 3 year survivals are greater than 80% for certain patients, and this is something our mesothelioma program team at Swedish are incredibly excited about.