The Thoracic Oncology Program at the University of Maryland Medical Center
is one of the pioneering institutions nationally using a finely tuned multidisciplinary
approach to the treatment of malignant mesothelioma and other asbestos-related
diseases. With our multidisciplinary care program, patients have access to all
of the team members in one visit. Treatment with medical, surgical and radiation
oncologists is coordinated through one specialized nurse. Communication is maximized
and patient stress and inconvenience is minimized. This "one-stop shopping"
approach has been found to be the best way to tackle the complex care for this
Malignant mesothelioma, an uncommon form of cancer, is a disease in which cancer
(malignant) cells are found in the sac lining the lung and chest cavity (the
pleura), abdomen (the peritoneum) and the heart (the pericardium). A layer of
specialized cells called mesothelial cells lines these cavities, forming tissue
called mesothelium. Tumors of the meothelium can be benign (noncancerous) or
malignant (cancerous). Most mesothelial tumors are cancerous; therefore, malignant
mesothelioma is often simply called mesothelioma.
Pleural mesothelioma is a malignant mesothelioma that spreads within the chest
cavity and sometimes involves the lung.
Asbestos exposure is the most common risk factor associated with mesothelioma.
Asbestos refers to a family of magnesium-silicate mineral fibers that have been
commonly used for insulation and in the shipbuilding and construction industries.
A history of asbestos exposure is found in 80 percent of patients who present
with mesothelioma. Other factors, which may promote mesothelioma, include: chronic
lung infections, tuberculous pleuritis, radiation (Thorotrast) and exposure
to the simian virus 40 (SV40) or mineral fibers (Zeolite). Although tobacco
smoking has not been associated with the development of mesotheliomas, the combination
of smoking and asbestos exposure greatly increases the risk of lung cancer.
- In the United States, 2,000-3,000 patients are diagnosed with malignant
pleural mesothelioma each year.
- Mesothelioma affects men more frequently than women and is more common in
- The median age of onset of symptoms is 70.
- Seven percent of workers exposed to asbestos become affected.
- The latent period between exposure to asbestos and the onset of symptoms
can be 20-40 years.
- The median survival time is between 4-12 months, depending on the stage
of presentation. The three-year survival is 10 percent and the overall five-year
survival is approximately 5 percent.
The severity of the condition varies from person to person, but in most cases
the onset of mesothelioma is usually very slow with the most common presenting
symptom being persistent pain localized in the chest. Sometimes the pain is
accompanied by severe difficulty in breathing or shortness of breath. Cough,
weight loss, fever and night sweats are less common.
At the University of Maryland Medical Center, a thorough radiologic evaluation
is performed to determine diagnosis. The evaluation is used to determine the
stage of the tumor and to assist in the design of therapy. Testing may include:
a chest X-ray, computed axial tomography (CAT Scan) of the chest and abdomen,
and a MRI of the chest. A lung pleural biopsy will generally be necessary.
The University of Maryland Thoracic Oncology Program has treatment plans that
may include surgery, chemotherapy, radiation therapy or a combination of these
There are three options for treatment depending on severity of disease.
1. Tri-modality Therapy
The unique multidisciplinary approach offered at UMMS involves surgery, radiation
therapy and chemotherapy. Although cure is not common in this disease this treatment
approach has been successful in slowing the progression of the disease as well
as in helping to relieve symptoms.
Current literature states that a single or bi-modality therapy for treatment
has not proven successful in improving survival rates and most treatment attempts
are usually unsuccessful in curing the disease.
For more information, please visit Lung Surgery
2. Chemotherapy Options
- A new drug therapy is being offered to malignant pleural mesothelioma patients
at UMMS using an antifolate drug called Pemetrexed (brand name Alimta™).
Research trials have reported that patients on this new chemotherapy drug
regimen live longer and have less pain than those on an older drug. Pemetrexed
is proving effective in targeting key enzymes thought to play a role in allowing
the rapid growth of this type of cancer. Pemetrexed is being offered in combination
with Gemzar on a Phase II study.
- UMMS is currently involved in a Phase
II Study of Single Agent Thalidomide for Unresectable Malignant Pleural Mesothelioma.
The principle objective for this study is to establish the activity of thalidomide
in patients with mesothelioma, particularly the group of patients not amenable
or who already failed to other treatments, e.g. surgery, radiation and chemotherapy.
3. Radiation Therapy
Radiation therapy directed to the area involved may alleviate some pain associated
with malignant mesothelioma.
For more information, please visit Chemotherapy
and Radiation Therapy.
Learn More About...
Learn more about the current approach to mesothelioma
treatment in this article written by Petr Hausner, M.D., Chief of Hematology/Oncology
at the Baltimore Veterans Affairs Medical Center.