A treatment plan is devised depending upon the mesothelioma type, aggressiveness, primary location, and degree of local (rarely, distant) spread. The treatment of pleural mesothelioma is difficult. Treatment with surgery, radiation therapy or chemotherapy used alone or in combination may be proposed, depending upon the potential benefits and risks of each modality. Surgery is rarely used alone, but sometimes suffices when only a small pleural patch of mesothelioma is detected, thus allowing visually complete removal of the tumor. More often, mesotheliomas of the left or right pleural cavity cannot be completely removed without taking the entire lung (pneumonectomy) on the same side as well. In such cases, radiation therapy and/or chemotherapy is given postoperatively to help eradicate any residual mesothelioma that may have escaped the surgeon.
The treatment of peritoneal mesotheliomas is even more problematic; until recently no consistent treatment was available. At our institution, peritoneal mesotheliomas have been managed in the experimental setting with combined modality treatment consisting of extensive (usually not complete) debulking surgery, followed by intraperitoneal and systemic chemotherapy followed in turn by whole abdominal radiation therapy.
Because mesotheliomas now represent less than one percent of cancers and and are infrequently seen in the practice of most community oncologists, finding the correct treatment can be very difficult. Proper management of mesotheliomas often requires evaluation at larger tertiary hospitals or Comprehensive Cancer Centers by specialists in medical, surgical and radiation oncology with experience in all aspects of the clinical care of mesothelioma patients, including the newest experimental treatments.