Mesothelioma Therapy

There are no clear guidelines for the treatment of mesothelioma. Commonly in stage 1 and in limited cases of stages 2 and 3 is expected to pleurectomy with decortication of the same or the pleuropneumectomia (plaura are removed and the portion of the lung involved) or, in the case of peritoneal localizations, the peritonectomy (removal of the peritoneum hit). At the end of the intervention may be associated CHEMOTHERAPY intracavitary hyperthermia, which involves continuous flushing of the surgical field with chemotherapy drugs to high temperatures, in order to “sterilize” the area and reduce the risk of recurrence. This can be done for both the pleural and peritoneal for that. In later stages is expected trimodal therapy, including surgery, radiation therapy and chemotherapy integrated adjuvant (after surgery to reduce the risk of recurrence). In stage 4 is provided only palliation; between these techniques is reminiscent of the pleurodesis. In doing so, to adhere the 2 peritoneal layers by chemical means, biological or mechanical to prevent spills and leaks. 2 / 2 The first act causing release of IL-8 by the pleural mesothelium, which attracting neutrophils to chemotaxis makes these scatenino inflammation and release of fibrin , hence the reference in the fibroblasts and fibrous reaction that joins together the two layers. The medium most frequently used to induce this phenomenon is the talc (talcaggio). This procedure is for the best outcomes for the low cost. Contraindications to the procedure the patient is terminal, with serious respiratory disorders, with adhesions, carcinomatous lymphangitis, or clotting disorders. The effectiveness is greater then if done in the early stages as the pleura and the lung respond better health. The treatments for pain to be proposed consists of analgesics , in radiation therapy and especially in chemotherapy, palliative. The combination premetrexed + cisplatin seems to be the best, however, be supplemented with vitamin B 12 and folate to prevent myelosuppression . This therapy is contraindicated in patients with clearance of creatinine less than 45 ml / min and in any case planning must be done by experts in this cancer oncologists.

Given the high mortality of this form of cancer various techniques of targeted therapy are being studied .