Intrapleural Mesothelioma Research Paper

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Intrapleural Chemotherapy for Treating Mesothelioma
Intrapleural perfusion of heated chemotherapy (ITH) is the chest counterpart of heated intraperitoneal chemotherapy (HIPEC). It is part of a surgical strategy traditionally used to treat pleural mesothelioma.

Treating Pleural Mesothelioma
Intrapleural chemotherapy can be given into the pleural cavity (the space between the lung and the lining of the lung). It is normally reserved for patients with very advanced disease, for which treatment options are limited. In the past, treatment options for these patients included traditional chemotherapy, radiation, and palliative care. Palliative or supportive care measures may include management of shortness of breath due to recurrent malignant pleural
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However, ITH combined with surgical resection of tumors may extend patients’ lives and relieve mesothelioma symptoms, improving quality of life overall.
What is Intrapleural Chemotherapy?
Intrapleural chemotherapy is the administration of chemotherapy drugs directly into the chest cavity. The drugs are administered through large or small chest catheters. It is part of a surgical strategy used to treat pleural mesothelioma and alleviate its symptoms.
Like with HIPEC, in ITH chemotherapy drugs are delivered directly to the chest cavity through chest catheters that may be connected to an implantable port. The catheters have a two-fold benefit, in that they are used to give drugs as well as to drain accumulated fluid, thereby relieving pleural pressure and pain.
ITH uses three strategies in one to eliminate as much cancer as possible: surgical resection, chemotherapy and heat. The goal of this three-pronged attack is to remove as many tumors and as much of the disease as possible. After complete resection of large pleural nodules and visible disease, the chest cavity is perfused with chemotherapy drugs heated to 40°C to 42°C to better kill microscopic cancer cells and minimally visible tumors that cannot be removed. The chemotherapy bathes the chest cavity, effectively eliminating the tumors without the level of toxicity one would find if the chemotherapy drugs were administered through the bloodstream. Heating
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ITH allows doctors to deliver higher doses of chemotherapy drugs that could be toxic if delivered to the entire body at the same doses. However, toxicity can be managed by confining the chemotherapy to a particular area. As a matter of fact, localizing treatment to the chest cavity can shrink and even eliminate some tumors.

The purpose of heated intrapleural chemotherapy for malignant pleural mesothelioma is to increase the exposure of cancer cells at the pleural surface to chemotherapeutic agents. Indeed, intrapleural chemotherapy can result in increased chemotherapy exposure for the cancer that is 60 to 100 times the systemic exposure.

This type of therapy works best to eliminate microscopic cancer cells and residual mesothelioma tumors, after complete surgical resection of all removal cancer. As such, ITH is a good option for mesothelioma patients whose tumors are not removable because of location, size or risks of complications. It can relieve symptoms and improve quality of life, or shrink tumors down enough to make them resectable. Sometimes this treatment is given in the operating room, right after surgery to remove the

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