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Peritoneal Mesothelioma Multimodal Treatment

Peritoneal Mesothelioma Multimodal Treatment

Peritoneal mesothelioma is a rare and aggressive form of cancer that affects the lining of the abdominal cavity (peritoneum). Multimodal treatment for peritoneal mesothelioma typically involves a combination of different therapeutic approaches to achieve the best possible outcome. These treatments can include surgery, chemotherapy, and sometimes radiation therapy. Here’s an overview of each component of multimodal treatment for peritoneal mesothelioma:

  1. Surgery:
    • Cytoreductive Surgery (CRS): CRS is the primary surgical procedure used to treat peritoneal mesothelioma. During CRS, the surgeon aims to remove as much of the visible tumor tissue as possible. This often involves the removal of the peritoneal lining and affected organs if necessary.
    • Peritonectomy: In some cases, specific peritonectomy procedures may be performed to remove the affected peritoneal lining and potentially involved structures such as the omentum or parts of the diaphragm.
    • Hyperthermic Intraperitoneal Chemotherapy (HIPEC): HIPEC is often combined with CRS. After removing as much tumor tissue as possible, heated chemotherapy is circulated in the abdominal cavity to target any remaining cancer cells.
  2. Chemotherapy:
    • Systemic Chemotherapy: Prior to or following surgery, systemic chemotherapy may be administered to shrink the tumor and target any cancer cells that have spread beyond the abdominal cavity. Common chemotherapy drugs used for peritoneal mesothelioma include pemetrexed and cisplatin.
    • Intraperitoneal Chemotherapy: Intraperitoneal (IP) chemotherapy involves delivering chemotherapy drugs directly into the abdominal cavity. This can be done during surgery (HIPEC) or as a separate procedure. IP chemotherapy can help to destroy remaining cancer cells and reduce the risk of recurrence.
  3. Radiation Therapy:
    • Radiation therapy is less commonly used for peritoneal mesothelioma compared to surgery and chemotherapy. However, it may be considered in certain situations, such as when the cancer cannot be completely removed surgically or when there is a risk of tumor seeding during surgery.
  4. Immunotherapy and Targeted Therapies:
    • Immunotherapy drugs like immune checkpoint inhibitors (e.g., pembrolizumab) and targeted therapies (e.g., bevacizumab) are being explored in clinical trials for the treatment of peritoneal mesothelioma. These therapies aim to harness the body’s immune system or target specific molecules involved in cancer growth.
  5. Supportive Care:
    • Palliative care and symptom management are essential components of the treatment plan to improve the patient’s quality of life and manage any side effects of treatment.

It’s important to note that the choice of treatment approach depends on various factors, including the stage of the disease, the patient’s overall health, and the expertise of the medical team. Multimodal treatment plans are often tailored to individual patients, and a multidisciplinary team of specialists, including surgical oncologists, medical oncologists, and radiation oncologists, work together to develop the most appropriate treatment strategy. Additionally, clinical trials may offer new and innovative treatment options for peritoneal mesothelioma. Patients and their healthcare providers should discuss the available treatment options and make informed decisions based on their specific circumstances.