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A Triple Threat to Mesothelioma

New York (Apr 15, 2009)

A multidisciplinary team of experts at NewYork-Presbyterian Hospital/Columbia University Medical Center's renowned Mesothelioma Center has developed a unique multidisciplinary approach that combines chemotherapy, surgery, and focused radiation therapy to treat mesothelioma while sparing as much nearby healthy tissue as possible. This lung-sparing approach is now being evaluated through a clinical trial offered only at the Hospital's Columbia University Medical Center campus.

Mesothelioma is a cancer that strikes some 3,000 people in the U.S. each year – primarily those who have been occupationally or environmentally exposed to asbestos. Eight-five percent of cases arise in the pleura (the lining of the lung) and the remainder in the peritoneum (the lining of the abdomen).

Treating Pleural Mesothelioma

Patients with pleural disease that cannot be surgically removed may benefit from this approach, starting with the insertion of two ports in front of and in back of the lungs under the guidance of a special scope. During this surgical procedure, patients also receive high-temperature chemotherapy to the pleura.

Next, over a period of eight to nine weeks, patients receive alternating weekly treatments of the anticancer drugs gamma interferon delivered directly into the pleura through the ports, as well as intravenous chemotherapy. Treatment can be given on an outpatient basis, enabling patients to return to the comfort of their homes the same day.

After they have completed chemotherapy, patients receive a single dose of a radioactive substance that bathes the pleural surfaces with high doses of radiation. (Patients with pleural mesothelioma cannot receive externally applied radiation therapy because it subjects the heart and lungs to potential radiation damage.)

"The isotope attacks any residual cells remaining after the other treatments," said Rashid A. Fawwaz, MD, PhD. "This approach of local irradiation has been used in the past to relieve pain and discomfort, but here it has curative intent."

"The most common treatment for pleural mesothelioma is a surgical procedure called 'extrapleural pneumonectomy,' but it rarely gets rid of all of the disease," explained Robert N. Taub, MD. "The actual data calls into question whether or not this surgery really helps. Through our approach, we have control over the pleural space and can give the patient higher, more effective doses of chemotherapy."

Treating Peritoneal Mesothelioma

The team is using a similar approach to treat peritoneal mesothelioma, called "intracavitary chemotherapy," which enables clinicians to deliver higher, targeted doses of chemotherapy directly into the abdomen with fewer side effects than conventional intravenous chemotherapy. About a third of all patients with peritoneal mesothelioma in this country are treated at NewYork-Presbyterian/Columbia.

Patients eligible for this treatment first undergo abdominal surgery to remove cancerous tissue, followed by the insertion of two ports – one on each side of the front of the body, below the ribcage. They then receive doxorubicin and cisplatin and periodic gamma interferon through the ports over the next 12 weeks.

After chemotherapy is completed, the patient undergoes a second operation during which time any remaining tumor tissue is removed, the ports are removed, and a final dose of high-temperature chemotherapy is applied. Findings of a clinical trial assessing the treatment showed that overall survival for patients receiving this therapy was 55 months, with 45 percent of patients living for at least five years.

Dr. Taub noted that the choice of chemotherapy drugs and the temperature, timing, and frequency of treatment still need to be refined in clinical trials. He concluded, "This is a procedure that shows great potential for treating this disease."

Contacting the Mesothelioma Center

For more information about this and other clinical trials at the Mesothelioma Center, contact Mary Hesdorffer, RN, Clinical Study Coordinator, at 212-305-4076.

Faculty Contributing to this Article:

Rashid A. Fawwaz, MD, PhD is an Attending Radiologist at NewYork-Presbyterian Hospital/Columbia University Medical Center, and a Professor of Clinical Radiology at Columbia University College of Physicians and Surgeons.

Robert N. Taub, MD is Director of the Mesothelioma Center at NewYork-Presbyterian Hospital/Columbia University Medical Center, and a Professor of Clinical Medicine at Columbia University College of Physicians and Surgeons.

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