Pleural Catheter Placement
Individuals with large volumes of fluid compressing their lungs can be treated in two main ways. They can either receive medication placed directly into the chest after drainage of the fluid (pleurodesis) or have a temporary catheter inserted (which can be drained at home a couple of times a week). There are multiple options for placement of a temporary pleural catheter, and the procedure can be performed by your surgeon under light sedation or anesthesia.
Surgery
Most stage I, II, and III pleural mesothelioma patients will be offered surgery as a treatment option.
Pleural mesothelioma surgery is designed to remove tumors from the chest cavity and the lining of the lungs. There are two common surgical procedures used for the treatment of pleural mesothelioma: extrapleural pneumonectomy (EPP) and pleurectomy with decortication (P/D).
Extrapleural Pneumonectomy
An extrapleural pneumonectomy (EPP) involves removing the entire lung affected by mesothelioma along with the lining of the chest wall (pleura), parts of the diaphragm, and possibly the lining of the heart (pericardium). This surgical option is appropriate if the tumor is heavily embedded in the lung tissue and cannot feasibly be removed. The surgeon replaces the removed parts of the diaphragm and pericardium with man-made materials.
An EPP is most effective for otherwise healthy patients with early-stage mesothelioma. It offers the best chance to remove all the cancer, especially when combined with chemotherapy and/or radiation therapy. However, it is a radical and complex operation performed only by highly experienced surgeons in specialized cancer centers like Fox Chase.
Pleurectomy/Decortication
A pleurectomy/decortication (P/D) may be referred to as “lung sparing” surgery. It involves partial removal of the affected lung. The surgeon may also remove parts of the chest wall lining, pericardium, and diaphragm (similar to what is removed during an EPP).
After the pleurectomy is completed, the surgeon performs a decortication, removing all visible tumors from the surface of the lung and the rest of the chest area.
Typically, patients who receive P/D have early-stage disease. Chemotherapy or radiation therapy are often used afterward to kill any remaining cancer cells and prevent recurrence.
Systemic Therapy
The medical oncologists at Fox Chase are regional and national leaders in the treatment of mesothelioma. As part of the multidisciplinary team, your medical oncologist will help to determine your personalized treatment plan, which may include systemic therapies, such as targeted therapy, immunotherapy, or chemotherapy, either as standard of care or as part of a clinical trial. Systemic therapy may be recommended to patients who are diagnosed after the cancer has spread to other parts of the body (metastatic cancer).
Radiation Therapy
Radiation, which uses high-energy beams to kill cancer cells, has various roles in the treatment of pleural mesothelioma. For patients who can undergo surgery, radiation is often used after chemotherapy and surgery as part of a multimodal therapy. Patients with advanced pleural mesothelioma who are experiencing painful symptoms may also receive radiation as a palliative treatment.
Radiation therapy is administered in conjunction with imaging, which tracks the pleural surface throughout the breathing cycle to ensure that the therapy can be administered effectively.
Interventional Pulmonology
Our interventional pulmonologists use advanced pleural drainage techniques to treat pleural effusions associated with pleural mesothelioma. Our pulmonologists also have extensive experience in perioperative management of mesothelioma patients, specifically in critical care areas and in patients with limited lung function.
“Pleural mesothelioma has traditionally been considered a lethal disease, and if patients get an ominous prognosis elsewhere, they may not realize all the treatment options that could have a positive impact on their prognosis. At Fox Chase, we are specialists in rare diseases, especially pleural mesothelioma.”
— Stacey Su, MD, FACS, Thoracic Surgical Oncologist