Newly Diagnosed?
We Can Help Getting the correct diagnosis and the most appropriate treatment from the start is crucial 
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Treatment is recommended to individual patients based on the stage of the cancer, the patient's general health, and how well the lungs function. Patients who are otherwise in overall good health and who have early-stage mesothelioma may be treated with chemotherapy, followed by surgery and radiation. Patients who cannot tolerate surgery or who have more advanced disease are generally treated with chemotherapy alone. The most commonly used chemotherapy regimen includes two drugs called pemetrexed (Alimta) and cisplatin. Memorial Sloan-Kettering is researching novel treatments for mesothelioma, and participation in a clinical trial may be offered.
Chemotherapy
Most patients will receive systemic chemotherapy to treat their mesothelioma. Recent studies have shown that combination chemotherapy of pemetrexed (Alimta) and cisplatin can increase survival and improve quality of life in patients with mesothelioma. This treatment is generally given every three weeks along with certain vitamins to decrease toxicity.
Patients with peritoneal mesothelioma may receive intraperitoneal chemotherapy, in which chemotherapeutic drugs are administered directly into the peritoneum (the membrane that lines the abdominal cavity).
Surgery
The type of surgery performed for mesothelioma depends on its stage and location. For pleural mesothelioma, surgery may be performed to remove the pleura, in an operation called pleurectomy; or for peritoneal mesothelioma, surgery may be performed to remove the peritoneum, in a procedure called a peritonectomy. For patients in otherwise overall good health who have early-stage pleural mesothelioma, surgeons at Memorial Sloan-Kettering may perform a more aggressive and difficult surgery called an extrapleural pneumonectomy, in which the pleura, the entire affected lung, and entire diaphragm are removed. If the entire tumor cannot be removed, radiation or chemotherapy may be given.
If a patient has a pleural effusion (fluid in the pleural space that can make breathing difficult), physicians may remove the fluid by thorocentesis. In this procedure, a patient is given a local anesthetic, and the physician places a needle through the skin of the chest wall into the pleura and withdraws fluid. A drain may be left in for a period of time to complete the draining process.
Patients with peritoneal mesothelioma may undergo a similar procedure, called paracentesis, in which fluid buildup (called ascites) is removed from the abdomen.
Another procedure may be performed to improve breathing, reduce pain, and prevent fluid from reaccumulating -- this is called pleurodesis. After removing fluid from the pleura, a physician will place a small amount of talc or another substance in the pleura using a tiny video camera inserted through a small incision in the side of the chest. This causes the pleura to adhere to itself and reduces fluid buildup around the lung.
Radiation Therapy
At Memorial Sloan-Kettering, we treat a large number of mesothelioma patients with radiation therapy. We have extensive experience with the use of intensity-modulated radiotherapy (IMRT) for the treatment of mesothelioma. IMRT uses sophisticated treatment planning and dose delivery techniques to precisely target a tumor and spare normal structures. We have pioneered the incorporation of positron emission tomography (PET) scanning into the treatment planning process. Patients receiving radiation usually begin their radiation therapy four to six weeks after surgery and receive treatments once a day, five days a week, for five to six weeks.
