Mesothelioma and Pleural Disease Treatment

Mesothelioma and Pleural Disease Treatment at Penn Medicine

When treating patients with mesothelioma or pleural disease, Penn Medicine pleural specialists offer more treatment options than most other health systems across the country and around the world.

Penn Medicine's Mesothelioma and Pleural Program and Penn's Abramson Cancer Center in Philadelphia, PA bring together internationally renowned experts in medical, surgical and radiation oncology and pulmonology who collaborate in the diagnosis, treatment and research of mesothelioma and pleural disease.

Focus on Mesothelioma

Mesothelioma is a rare type of cancer that affects the lining of the chest or abdominal cavities. It is most often attributed to exposure to airborne asbestos particles and occurs in both men and women. Asbestos fibers are naturally occurring fibrous minerals that were commonly used in construction and thermal insulation as a fire retardant until the 1970s. Asbestos is still used in products, but regulations in place since the 1980s limit its use.

Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.

Penn's multidisciplinary approach to cancer diagnosis and treatment provides better outcomes and gives patients access to the most advanced treatment, surgical techniques and clinical trials.

Read more About Mesothelioma and Pleural Disease Treatment at Penn Medicine

Diagnosing Mesothelioma and Pleural Disease

An accurate diagnosis is the key to providing patients with the high level of care that they require for mesothelioma or pleural disease. At Penn, specialists who have extensive experience diagnosing and treating these complex conditions employ the latest tests and tools to provide patients with a timely, accurate diagnosis.

Read more Mesothelioma and Pleural Disease Diagnosis

Mesothelioma and Pleural Disease Treatment

Penn Medicine's pleural specialists develop personalized treatment plans for patients with mesothelioma and pleural disease, designed to give every patient the best possible outcome. Penn's treatment options for mesothelioma and pleural disease include:

  • Surgery
    • Extrapleural pneumonectomy
    • Indwelling pleural catheter (IPC)
    • Lung-sparing surgery
    • Minimally invasive surgery
    • Peritoneal cytoreductive surgery
    • Pleural sclerosis and fibrinolytics
    • Therapeutic thoracentesis
    • Thoracotomy
    • Video-assisted thoracoscopic surgery (VATS)
  • Radiation Therapy
    • Brachytherapy
    • Intensity-modulated radiation therapy (IMRT)
    • Photodynamic therapy (PDT)
    • Proton therapy
    • Volumetric-modulated arc therapy (VMAT)
  • Chemotherapy and Biologic Therapies
    • Combination chemotherapy
    • Immunotherapy
    • Targeted therapies
    • Gene therapy
    • Adjuvant therapy
  • Interventional Pulmonology Treatments
    • Endobronchial ultrasound-guided biopsy and mediastinal staging
    • Pleuroscopy and pleurodesis
  • Clinical Trials
  • Other Treatments
    • Integrative medicine and wellness
    • Palliative care
    • Penn Home Care and Hospice

Patients who come to Penn Medicine for their cancer care benefit from coordinated care across disciplines and modalities. The expertise of Penn's Abramson Cancer Center in cancer diagnosis, treatment planning and integrated medicine, helps patients who come to Penn Mesothelioma and Pleural Program receive nationally recognized care that leads to better outcomes and improved quality of life.


Mesothelioma and Pleural Disease Surgery

Surgery is a valuable tool for treating mesothelioma and pleural disease. Penn Medicine's internationally recognized surgical experts collaborate closely with their colleagues in radiation and medical oncology to develop individualized treatment approaches for patients.

Treatment plans depend largely upon the location and stage of the tumor as well as the patients' overall health. In all cases, Penn's specialists strive for the safest and least invasive treatment options to preserve quality of life.

Extrapleural Pneumonectomy

Surgeons remove the lung, pericardium (membrane covering the heart), part of the diaphragm (muscle between the lungs and abdomen), and part of the parietal pleura (membrane lining the chest) to treat malignant mesothelioma.

Indwelling Pleural Catheter (IPC)

Patients with recurrent pleural effusion are sometimes treated with an indwelling pleural catheter. The device, inserted into the pleural space by Penn surgeons, removes excess fluid from the chest cavity and relieves symptoms associated with pleural effusion while allowing patients to remain at home.

Lung-sparing Radical Pleurectomy or Peritonectomy

Patients with mesothelioma may undergo a pleurectomy (removal of the lining around the lungs) or peritonectomy (removal of the membrane that lines the cavity of the abdomen) to remove diseased tissue. Penn surgeons combine this procedure with photodynamic therapy and are achieving promising results.

Peritoneal Cytoreductive Surgery

The goal of cytoreductive surgery, sometimes called “debulking” surgery, is to remove as much of a tumor as possible. It is commonly combined with radiation therapy or chemotherapy.

Pleural Sclerosis and Fibrinolytics

Pleural sclerosis is used to obliterate the pleural space in order to prevent the recurrence of a spontaneous pneumothorax or the reaccumulation of a pleural effusion. Many different agents, ranging from antibiotics to talc are used to eliminate the space in which air or fluid can accumulate.

Therapeutic Thoracentesis

This simple procedure drains the fluid and relieves the symptoms of pleural effusion. It may also be used as a diagnostic test to look for causes of a pleural effusion. During therapeutic thoracentesis, physicians insert a needle into the pleural space to remove the fluid, relieving the pressure on the lungs and making breathing easier.

Thoracotomy

Surgeons make an incision between the ribs on one side of the chest to remove all or part of a lung, avoiding the heart and spinal cord.

Video-assisted Thoracoscopic Surgery (VATS)

This minimally invasive technique is used to diagnose and treat problems in the chest. A tiny camera called a thoracoscope and surgical instruments are inserted in the chest through small incisions, and the thoracoscope transmits images to a video monitor, guiding the surgeon in performing the procedure. VATS can be used to perform a biopsy, to remove tumors or remove an entire lobe from the lung

Radiation Therapy for Mesothelioma and Pleural Disease

Radiation therapy's ability to precisely target and attack diseased tissue – thereby slowing or stopping tumor growth – makes it an integral component of many treatment plans developed by Penn's Mesothelioma and Pleural Program. Penn Radiation Oncology offers patients the full complement of radiation treatments including proton therapy – a powerful tool available at only a few centers in the nation.

Brachytherapy

Brachytherapy involves placing small, radioactive implants, such as metal pellets, seeds, ribbons, wires, needles, capsules, or tubes in small, sealed holders inside the body. This is done in a hospital operating room and requires imaging technology (such as X-ray or MRI) to determine the exact location for the radiation to be placed to most effectively treat the cancer. Implants may be left in the body for only a short time, or permanently.

The advantage of brachytherapy is that it delivers a high dose of radiation to a smaller area than may be possible with external radiation treatment, which is delivered by machines located outside the body.

Intensity-modulated Radiation Therapy (IMRT)

IMRT is a form of radiation therapy administered by a linear accelerator – a computer-controlled device that delivers precise doses of radiation to tumors or specific areas within the tumors. Because IMRT uses 3-D computed tomography (CT) images and computerized dose calculations, it can conform, or modulate, the radiation beam more precisely to the shape of the tumor. This helps ensure that exposure to healthy surrounding tissue is minimized.

Photodynamic Therapy (PDT)

Penn was the first health system in the Philadelphia region to use PDT to treat pleural cancers. Also known as photoradiation therapy, phototherapy, or photochemotherapy, PDT brings together light-sensitive medication (photosensitizer) and low-level beams of light to destroy cancer cells. Photosensitizers are drugs that, when exposed to a specific wavelength of light, produce a form of oxygen that kills nearby cells. PDT can also shrink or destroy tumors by damaging the blood vessels that feed them, depriving the tumor of nutrients. Additionally, PDT may activate the immune system to attack the tumor cells. Intraoperative photodynamic therapy is combined with radical pleurectomy for treating pleural malignancies.

Proton Therapy

Penn Medicine's Roberts Proton Therapy Center is the largest and most sophisticated facility in the world for this advanced form of radiation treatment. Proton therapy is external beam radiotherapy in which protons are directed at a tumor. The radiation dose that is given through protons is very precise, and limits the exposure of normal tissues. This allows the radiation dose delivered to the tumor to be increased beyond conventional radiation. The result is a better chance for curing cancer with fewer harmful side effects.

Proton therapy, like all forms of radiation therapy, works by aiming the energized particles — in this case protons — onto the target tumor. The particles damage the DNA of cells, ultimately causing their death. Unlike X-rays, protons can be manipulated to release most of their energy only when they reach their target. With more energy reaching the cancerous cells, more damage is administered by each burst of radiation.

Volumetric-modulated Arc Therapy (VMAT)

VMAT radiation beams sweep in uninterrupted arc(s) around the patient, speeding treatment delivery and reducing treatment time. Imaging increases the precision and allows physicians to visualize the tumor target at the time of treatment and to guide therapy that both maximizes the radiation dose to the target and minimizes exposure to surrounding healthy tissues.

Chemotherapy and Biologic Therapies for Mesothelioma and Pleural Disease

Penn Medicine specializes in a team approach to treatment with interdisciplinary care and innovative approaches that use chemotherapy to target tumors prior to and after surgery.

Medical oncologists at Penn's Abramson Cancer Center are experts in treating cancer with chemotherapy and other adjuvant approaches. They lead the way in developing new targeted therapies such as the use of monoclonal antibodies, vaccines and immune-based therapies.

Adjuvant Therapy

Adjuvant therapy is treatment given after surgery. It is often used in combination with other forms of cancer treatment to reduce the chance of recurrence. These therapies may include chemotherapy, hormone therapy, targeted therapy, immunotherapy (biologic therapy) or vaccine therapy.

Chemotherapy

Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy is taken by mouth or injected into a vein or muscle, depending on the type and stage of the cancer being treated. The drugs enter the bloodstream and can reach cancer cells throughout the body. Multiple drugs that attack cancer in different ways can be combined to increase their effectiveness.

Gene Therapy

Researchers at Penn Medicine are pioneering the use of two forms of gene therapy for treating mesothelioma. In the first, a new gene is placed in a modified cold virus and inserted into the tumor itself. This new gene makes a substance called interferon that causes the body to reject the tumor using its own immune system.

In the second approach, patients' own white blood cells are collected and modified to recognize the tumor. When injected back into the patient, they attack and kill the tumor.

Immunotherapy

Immunotherapy uses patients' own immune systems to fight cancer. Penn medical oncologists use biologic or synthetic agents to repair, stimulate or enhance the immune system, triggering the body's natural defenses to eliminate the cancer cells.

Targeted Therapy

At Penn, medical oncologists sometimes use targeted therapies, such as drugs or other substances to block the growth and spread of cancer by interfering with specific molecules involved in tumor growth and progression.

Interventional Pulmonology Treatments for Mesothelioma and Pleural Disease

Endobronchial Ultrasound-guided Biopsy and Mediastinal Staging

Endobronchial ultrasound-guided biopsy is a non-surgical method for detecting mediastinal lymph node metastases in early-stage lung cancer. The bronchoscopic technique uses ultrasound to visualize the structures within and adjacent to the airway wall while using a fine needle to remove cells for examination.

Pleuroscopy and Pleurodesis

A treatment for severe recurrent pleural effusion, a pleuroscope is used to inspect the pleura and take biopsies of suspicious areas. The space between the pleura is then coated with medication to prevent the reaccumulation of fluid.

Clinical Trials at Penn Medicine for Mesothelioma and Pleural Disease

Today, more and more people are surviving cancer. Clinical trials benefit patients with access to breakthrough therapies and treatments. These new advances in cancer treatment are occurring every day at Penn Medicine, giving patients hope that even greater discoveries lie ahead.

Through clinical trials:

  • Diagnosing cancer has become more precise.
  • Radiation and surgical techniques have advanced.
  • Medications are more effective.
  • Combinations of medical, surgical and radiation therapy are improving treatment effectiveness and enhancing outcomes.
  • Strategies to address the late effects of cancer and its treatment are improving quality of life.

At Penn, members of the Mesothelioma and Pleural Disease program are:

  • Exploring ways to improve and expedite the diagnostic process through a greater understanding of mesothelioma's genetic links
  • Aggressively studying the use of photodynamic therapy (PDT) and proton therapy, two technologies that are showing promise in the treatment of mesothelioma

In all cases, research is focused on enhancing and extending the quality of life with the ultimate goal of curing cancer.

Other Treatments at Penn Medicine for Mesothelioma and Pleural Disease

In addition to standard treatments and clinical trials, patients at Penn Medicine may wish to add other therapies and treatments such as massage therapy, acupuncture and art therapy. These therapies do not have curative intent, and are designed to complement standard treatments, not take their place.

Integrative Medicine and Wellness Programs

At Penn Medicine, integrative medicine and wellness services can supplement traditional cancer treatments such as chemotherapy, surgery and radiation therapy. While conventional medicine plays a critical role in eradicating cancer, integrative medicine and wellness programs offer patients and their families ways to enhance the quality of their lives, minimize or reduce the side effects of cancer and cancer treatment, and promote healing and recovery.

The physicians at Penn Medicine are knowledgeable and supportive of complementary cancer treatments. The cancer team works with patients and families to integrate these supportive programs into the overall care plan, while ensuring the safety and health of patients.

The Abramson Cancer Center's range of integrative supportive services is designed to help patients cope with the cancer experience and improve their overall sense of well-being. Services include:

The Abramson Cancer Center at Pennsylvania Hospital offers a variety of supportive care programs for patients and families, from diagnosis through survivorship. These programs are available at no cost to the patients treated at Pennsylvania Hospital, and some are open to patients treated elsewhere. These services include social work counseling, nutrition counseling, psychological counseling and spiritual counseling.

The Cancer Appetite and Rehabilitation Clinic focuses on patients with loss of appetite and weight, as well as the weight loss, muscle atrophy, fatigue and weakness that can accompany cancer treatment.

The Supportive Care Clinic helps to manage cancer related symptoms. Integrative support programs include:

Support groups and educational programs are available at Pennsylvania Hospital throughout the year.

Palliative Care at Penn Medicine

Palliative care provides medical and non-medical interventions to ease the symptoms of cancer and its treatment. Palliative care includes physical, emotional and spiritual care that can enhance the quality of life for cancer patients.

Palliative care can be used to complement traditional cancer therapies, or can be used when curative therapies are no longer an option to treat symptoms and improve quality of life.

Palliative care is an approach to patient care that can be integrated with curative therapies at any point from diagnosis to survivorship or end-of-life care.

Palliative care services include palliative chemotherapy, radiation therapy and surgery as well as psychological counseling, art therapy and support groups for patients and families. The goals of palliative care are to enhance the quality of life for cancer patients and their families, and provide emotional and spiritual support to enhance personal growth.

Palliative care services are offered at the Hospital of the University of Pennsylvania and Pennsylvania Hospital.

Penn Home Care and Hospice Services

Penn Home Care and Hospice Services offer a full range of home health care needs by partnering three top-level home health care services under one roof:

Penn Home Care and Hospice Services provide an array of specialized therapies and medications for patients with cancer and cancer-related conditions.

Mesothelioma and Pleural Disease Survivorship

At Penn Medicine, significant research in the diagnosis and treatment of mesothelioma and pleural disease is giving patients with these conditions new hope for long-term survival.

To meet patients' varied physical, emotional and financial needs, Penn's robust network of navigation specialists includes social workers, stress management specialists, alternative medicine practitioners and clergy. Additionally, the support groups and survivorship programs at Penn provide patients and their families with a valuable network that serves to enhance and extend the quality of life following a cancer diagnosis.

Read more Mesothelioma and Pleural Disease Survivorship


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