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Mesothelioma Treatment: Surgery, Chemotherapy and Radiation Therapy

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Mesothelioma Treatment: Surgery, Chemotherapy and Radiation Therapy

Mesothelioma Treatment Options

Mesothelioma cancer can treated with conventional therapies such as surgery, chemotherapy and radiation, according to the latest study in the American Society of Clinical Oncology. Emerging cancer treatments, including immunotherapy, are also available for some patients. Though not every patient is eligible for each type of mesothelioma cancer treatment, most patients can benefit from palliative care to help manage symptoms.

The most common treatment for mesothelioma involves a combination of surgery, chemotherapy and radiation therapy. Supportive treatments can help relieve symptoms and improve quality of life for many mesothelioma patients.

Methods Of Treating Mesothelioma

Current recommendations for treating mesothelioma come from The American Society of Clinical Oncology. This group reviews and implements evidence-based updates on an ongoing basis. Specialists follow these clinical practice guidelines when treating asbestos-related diseases.


Surgery: Patients diagnosed in the early stages benefit most from mesothelioma surgery. It offers them the best chance at living longer lives. These procedures, often performed with chemotherapy, remove all visible tumors from the chest area and improve quality of life.
These procedures are used for diagnosing disease, removing tumors and easing pain. Extrapleural pneumonectomy or pleurectomy and decortication surgeries offer the greatest chance of survival for patients with strong health and limited cancer spread.
Chemotherapy: Doctors may recommend chemotherapy to mesothelioma patients deemed ineligible for surgery. Chemotherapy also helps extend survival rates. A 2016 Wayne State University study found patients given a chemo drug combination lived three times longer than patients without it.
More than 70% of patients undergo chemotherapy. The therapy’s strong drugs shrink tumors and kill cancer cells but also come with treatment side effects.
Radiation: Radiation therapy controls symptoms when surgery is not an option. It eases symptoms such as chest pain and discomfort. Radiation can also reduce the risk of local recurrence when combined with surgery, and it can be used as a palliative procedure.
Radiation therapy can be administered at any cancer stage. Doctors use it to reduce pain and slow tumor growth. It is often combined with surgery and chemotherapy.

Multimodal Therapy: Multimodality treatment is the combination of two or more conventional treatments to treat the pleural and peritoneal types of mesothelioma. This combined approach controls cancer growth better than using only one treatment.

Tumor Treating Fields: Tumor Treating Fields, or TTFields, uses alternating electrical fields to disrupt cancer cells and limit growth. FDA approved, and ASCO recommended, a portable battery device delivers this treatment for malignant pleural mesothelioma through the skin via insulated adhesive pads.
This FDA-approved cancer therapy treats pleural mesothelioma. TTFields works in combination with chemotherapy to limit cancer growth and improve survival.
Immunotherapy: Bevacizumab is an ASCO-recommended immunotherapy drug for mesothelioma that uses antibodies to limit tumor growth. Other types of immunotherapy for treating mesothelioma, such as the FDA-approved pembrolizumab (Keytruda), help the immune system identify and kill cancer cells.
Immunotherapy drugs control cancer growth and help some mesothelioma patients live longer. Doctors use immunotherapy at any stage, and success rates vary for each patient.

Treatments Based On Mesothelioma Type

The primary treatment options for pleural and peritoneal mesothelioma include surgery, chemotherapy and radiation therapy. These treatments can relieve symptoms, improve prognosis and extend life expectancy.

Benefits and risks of each option depend on cancer type and stage. For example, hyperthermic intrathoracic chemotherapy (HITHOC) for pleural mesothelioma is considered experimental and has not yet yielded the success rate that heated intraperitoneal chemotherapy (HIPEC) has for peritoneal mesothelioma.

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Pleural Mesothelioma Treatments

Pleural mesothelioma affects the pleura, the outer lining of the lungs. Almost 75% of mesothelioma cases are pleural. Doctors prescribe treatments to remove or shrink pleural tumors, minimizing symptoms and improving quality of life.


Extrapleural Pneumonectomy (EPP): EPP removes the entire affected lung and all nearby areas where mesothelioma has spread, including lymph nodes, chest and heart linings and diaphragm.

Pleurectomy Decortication (P/D): P/D spares the lung and only removes cancerous parts of the pleural lining, chest wall lining, heart lining and diaphragm. P/D is less aggressive than EPP but is still major surgery.

ChemotherapyCombination Chemotherapy: For first-time, or first-line, treatment with mesothelioma chemotherapy drugs, doctors often prescribe pemetrexed (Alimta) with cisplatin. If cancer returns, second-line options may include gemcitabine (Gemzar) or carboplatin.

RadiationExternal Beam Radiation Therapy: EBRT is the most common radiation treatment for mesothelioma. An external machine delivers X-ray beams to kill cells at the cancer site. Doctors may use EBRT before or during surgery.

Brachytherapy: This type of radiation is internal and uses a radioactive implant inside the patient to kill nearby cancer cells. Similar to EBRT, doctors may combine brachytherapy with other conventional treatments.


Palliative Care for Mesothelioma

Mesothelioma palliative treatment is also known as supportive care with a focus on controlling symptoms. It can improve quality of life and relieve cancer and treatment symptoms.
  • Thoracentesis

    This procedure involves a long needle inserted into the pleura to remove fluid buildup around the lungs.
  • PleurX Catheter

    Surgeons place this small drain in the chest to prevent fluid buildup around the lungs.
  • Pleurodesis

    A more invasive procedure, this surgery eliminates the space in the pleura where fluid can develop.
  • Radiation

    Radiotherapy in combination with other treatments can shrink tumors to reduce chest pain and other cancer symptoms.
  • Paracentesis

    Similar to a thoracentesis, this procedure for peritoneal patients uses a long needle to remove fluid buildup and reduce pressure from the abdominal area.
  • Pericardiocentesis

    To remove fluid and pressure from the sac surrounding the heart, doctors perform a pericardiocentesis, similar to thoracentesis and paracentesis.

Clinical Trials & Emerging Treatments

Mesothelioma doctors and researchers are testing these emerging treatments in clinical trials to ensure safety and efficacy.

The goal of clinical trials is to find a mesothelioma cure or improve life expectancy. At some point, these experimental therapies could become conventional options.


Cryotherapy: Cryotherapy is a minimally invasive surgical procedure that freezes cancer cells to kill them. Patients may receive the therapy before surgery to shrink tumors, after surgery to treat recurrences or as a palliative treatment to control symptoms.
Gene Therapy: Genetically modifying cells and viruses can help control cancer. For example, repairing the defective tumor-suppressing p53 gene kills cancer cells before they can replicate out of control.
b After injecting a light-sensitive drug into the patient, doctors use laser light energy to activate the drug and kill cancer cells.
Virotherapy: Virotherapy is a cancer treatment that uses viruses to find and attack cancer cells. Some types of virotherapy involve gene therapy or immunotherapy to make the treatment more effective.

Nutrition & Self-Care During Mesothelioma Treatment

A healthy diet and mindful self-care routines are essential techniques to round out a complete mesothelioma treatment plan. Overall wellness can help reduce side effects, improve mesothelioma prognosis and extend patient survival.

Diet & Nutrition

Following proper nutrition guidelines, advice and a treatment plan from a dietitian can improve a patient’s well-being and recovery time.

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As a part of any treatment plan, patients should try to keep a balanced diet to maintain weight and energy. Maintaining an appropriate weight before surgery can reduce the risk of infection.

Diets rich in protein and calories can benefit every cancer patient before, during and after treatments such as chemotherapy and surgery.

Protein allows muscles to heal faster from damage during surgery. Increased caloric intake gives your body the energy to repair cells and tissues injured during chemotherapy or radiation

However, some mesothelioma treatments can make eating more difficult. Several techniques, including certain foods and meals, can manage these challenges. Some patients may consider taking over-the-counter vitamins or supplements, but they should always talk with their doctor first.


Complementary & Alternative Medicine

While these practices and supplements are not conventional cancer treatments, some patients may use these alongside their cancer treatments to reduce pain or improve well-being. Patients should consult their doctor before using any supplement or alternative medicine.

  • TENS Therapy

    Small at-home devices use low-voltage electrical stimulation over the skin to relieve muscle pains.

    Transcutaneous Electrical Nerve Stimulation, known as TENS therapy, uses low-voltage electrical current to relieve pain. Cancer patients can safely use TENS therapy from the comfort of their home. They do not have to visit a medical center to receive this therapy.

    A 2015 study published in Pain Medicine found that TENS therapy significantly relieved cancer-related pain for roughly 70% of participants.

  • Acupuncture & Massage

    Thin needles stimulate nerves and muscles to relieve pain. Therapeutic massage can lower fatigue and anxiety.

    Acupuncture is an ancient Chinese treatment in which thin needles are inserted into the skin to relieve pain and stress built up in the body. Acupressure is similar to acupuncture, but it uses finger pressure instead of needles to stimulate acupuncture points.

    • The World Health Organization reports that acupuncture can relieve adverse reactions to chemotherapy and radiation therapy.
    • A 2013 study published in the Journal of Clinical Oncology that found auricular (ear) acupuncture significantly reduced the intensity of pain felt by cancer patients over a two-month period.
    • A 2000 study published in Oncology Nursing Forum reported significant anxiety reduction among lung cancer patients who received reflexology, a form of acupressure applied to the feet.
  • Medical Marijuana

    Natural compounds reduce chemotherapy side effects such as nausea and vomiting, loss of appetite, pain and insomnia.
    Medical marijuana is considered an herbal medicine, and research shows it may help relieve pain and chemotherapy-induced nausea in cancer patients. Scientific studies also suggest it may improve appetite during chemotherapy and help cancer patients with insomnia.
  • Herbal Medicine

    Botanical products that may ease symptoms related to treatment or the cancer, and they may improve immunity.

    Herbal medicines are made from plants and administered in capsules, powders, teas, creams and tinctures. Examples of herbal medicine include Essiac tea, mistletoe extracts and turmeric.

    Some scientific research suggests certain herbs may improve cancer symptoms and reduce side effects of treatment, while other herbs may interfere with cancer treatment. Plant-based medications are an essential part of traditional Chinese medicine.

    A 2020 study published in Molecules reported on four plant extracts traditionally used in Thailand on lung cancer patients receiving chemotherapy. The extracts were found to kill lung cancer cells and promoted the effects of chemotherapy.

  • Energy Therapies

    Treatments such as music therapy, Therapeutic Touch or reiki may soothe patients but are not effective in cancer care.

    Energy therapies include a variety of techniques that intend to heal a person using “energy.” These therapies are based on a belief in a form of energy known as “life force energy,” which hasn’t been proven to exist in scientific studies. It is important to note that while energy therapies may be used as a complementary therapy, there is no scientific evidence to support their use in cancer care.

    The primary energy therapies used by people facing cancer include music and sound therapy, Therapeutic Touch and reiki.

  • Mind-Body Therapies

    Techniques such as hypnosis and biofeedback may reduce pain and discomfort using thought exercises and whole-body mindfulness.

    Certain mind-body therapies have been scientifically studied in cancer patients, including yoga, tai chi, qigong and meditation.


    While the following studies report on the benefits of yoga for cancer patients, not every form of yoga is safe for people with cancer to practice. Mesothelioma patients should avoid aggressive or hot styles of yoga, such as Bikram or power yoga, and instead opt for gentler versions of yoga such as hatha or yin yoga.

    • A 2017 review published in Supportive Care in Cancer studied the effects of yoga among cancer patients actively undergoing treatment. Patients in the study reported that yoga improved sleep, lessened fatigue, reduced distress and eased anxiety and depression.
    • A 2013 study published in the Journal of Complementary and Integrative Medicine reported that practicing yoga improved respiratory function in lung cancer patients by increasing the amount of air they could exhale over a 14-week period.
    • A 2012 study published in the Journal of Alternative Complementary Medicine found that yogic breathing techniques helped cancer patients cope with the side effects of chemotherapy in addition to improving sleep, anxiety levels and mental quality of life.

    Tai Chi and Qigong

    Qigong and tai chi are similar mind-body disciplines that unite flowing, slow-motion movement with breathing and mindfulness. These mind-body practices are gentle and considered safe for people with mesothelioma to practice.

    • A 2014 review published in Complementary Therapies in Medicine looked at 13 controlled trials studying the effects of tai chi or qigong in cancer patients. The review found that tai chi and qigong improved quality of life and mental health, lessened fatigue, reduced inflammation and even improved survival rates in liver cancer patients.
    • A 2015 study published in Annals of Behavioral Medicine found that tai chi and qigong significantly improved fatigue among breast cancer survivors within a short amount of time. The study also reported continued practice of tai chi or qigong improved depression and sleep quality.


    At its core, meditation is simply a practice of awareness. Some forms of meditation are spiritually focused, while others focus on mindfulness. Meditation is considered safe for people with mesothelioma to practice, but patients should not participate in any form of meditation that requires fasting from food or water.

    • A 2013 study published in Complementary Therapies in Medicine investigated the effects of practicing meditation among breast cancer patients undergoing radiation therapy. It reported that meditation reduced anxiety, lessened fatigue and improved quality of life.
    • A 2001 study published in Supportive Care in Cancer followed 89 cancer patients in a seven-week Mindfulness-Based Stress Reduction program. Participants reported immediate improvements in their sleep quality, fatigue, stress and mood, and maintained these benefits through their six-month, follow-up visit.
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