Methods for Administering Chemotherapy for Malignant Mesothelioma

Intra-arterial chemotherapy treatments

Intra-arterial chemo medications are administered into the artery that supplies blood to the cancerous tumor. A special x-ray technique, called angiography, makes use of a dye to mark blood vessels and identify the arteries supplying blood to the malignant tumor. Currently, two different techniques are available for administering medications intra-arterially.

Temporary external catheter: The radiologist can implant a temporary catheter in the targeted artery and remove the same after the medication has been administered. The site where the catheter is inserted should be monitored carefully to check for bleeding.
Implanted pump: Using surgical procedures, doctors can implant a pump inside the subcutaneous tissue (the region between the skin and the muscle). In this procedure, the catheter is threaded to the artery. Once the therapy is over, the pump can be removed.
Although, this technique is most commonly used to treat colon cancer that may have spread to the liver, there have been cases where it has been used to treat cancers of limb sarcoma, head and neck, limb melanoma, pancreatic cancer, gastric cancer and others.
The primary logic for this particular technique is that the cancerous tumor will have maximum exposure to the chemotherapy drug without the risk of toxicities associated with administering these drugs systemically (all throughout the body). Although improved tumor responses have been achieved with this treatment, there have been no instances of survival benefits till date.

Intravesicular chemo treatments

In this technique, chemo medications are administered via a urinary catheter that is passed into the bladder.

A urinary catheter is implanted, after which the chemo drugs are injected in the catheter. The catheter is then clamped to allow the drug to remain inside the bladder.
Patients are then asked to roll over gently from side to side and lie flat on their backs so that the drug can reach all affected areas inside the bladder.
After a specific time frame, the clamp is loosened, the fluid is drained out and the catheter is removed.
This treatment procedure is often used for patients diagnosed with superficially invasive bladder cancer (cancer occurring on the bladder surface that cannot be removed).

Intrapleural chemotherapy treatments

Chemotherapy treatment can be administered in the pleural cavity (the region that separates the lung and the lining of the lung). This technique is used to manage malignant pleural effusion, which is characterized by the build up of cancerous fluid inside the pleural cavity. The fluid can induce the lung to collapse, which can hamper breathing. Removing the fluid can alleviate symptoms, but the fluid will generally accumulate again unless doctors administer intrapleural chemotherapy. This procedure is also referred to as sclerosis or pleurodesis. Pleural mesothelioma is sometimes treated this way.

The accumulated fluid is drained (this can take several days) via a chest tube inserted in the pleural cavity. Chemotherapy drugs are administered through the chest tube.
The chemotherapy treatment makes the lung to stick to the lining of the pleura, thereby allowing it to re-expand and remain expanded.
This treatment procedure is used mainly for providing symptomatic relief.

Implantable chemotherapy treatments

Designed to deliver the chemotherapy medication called carmustine, the Gliadel® wafer can be placed and left inside the cavity created after a brain tumor (especially glioblastoma multiforme) is surgically removed. This special carmustine wafer formulation allows doctors to administer the drugs exactly at the site of occurrence of the brain tumor. After removing the cancerous tissues from the brain, the surgeon places up to 8 wafers (dime-sized) inside the surgical cavity, the space that was earlier occupied by the tumor. The wafers continue to dissolve over the next two to three weeks, delivering the chemo medication to the surrounding cells. The objective of this treatment procedure is to destroy cancer cells that may remain after surgery.

Questions and Administration on Chemotherapy Administration for Mesothelioma

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