In a trimodal approach to the treating mesothelioma, patients receive a combination of radiation therapy, chemotherapy and surgery to try to stop tumors from growing. Using a trimodal approach increases the survival rates of the patients.

What Is a Trimodal Approach?

A trimodal approach to the treatment of mesothelioma uses a combination of surgery, chemotherapy and radiation therapy. Each time doctors use the trimodal approach it’s slightly different depending on the patient and their cancer.

The combination of the three treatment forms will happen in one of 3 ways: adjuvant, neoadjuvant or intraoperative.

Adjuvant Therapy

In adjuvant therapy, the additional treatments come after the primary type of treatment. For example, after a patient has undergone an extrapleural pneumonectomy—surgery where the lung and surrounding tissue is removed—a patient would then undergo chemotherapy and radiation therapy to kill any microscopic cancer cells left over after the surgery.

The purpose of adjuvant treatments is to reduce the risk of recurrence.

Neoadjuvant Therapy

Unlike adjuvant therapies, which occur after the primary form of care (typically surgery), neoadjuvant therapies happen before. These therapies are used to make the primary treatment more effective.

One example of a neoadjuvant treatment would be Surgery for Mesothelioma After Radiation Therapy or SMART.

SMART is when a patient receives a high concentration of radiation to the lungs and other affected tissue in Intensity Modulated Radiation Therapy (IMRT). Then about 6 days later, the patient undergoes an extrapleural pneumonectomy (EPP) or surgery to remove the lung and other affected tissue.

While SMART is technically not a trimodal therapy (it only uses radiation therapy and surgery) it’s sometimes used in combination with chemotherapy, depending on the patient and doctor.

Intraoperative Therapy

In an intraoperative approach, the patient receives chemotherapy and radiation therapy while they are having surgery.

This helps control the size of the tumor and keeps it from spreading, which makes surgery easier.

However, the amounts of chemotherapy and radiation therapy that a patient can receive are limited by the presence of healthy tissue.

Benefits of Combining 3 Standard Mesothelioma Treatments

One of the benefits of using a trimodal approach is that adjuvant therapies have been shown to lower the likelihood of a tumor coming back. Although, merely using a trimodal approach is not a guarantee that the patient’s cancer will not come back.

The main benefit of using a trimodal approach to treating mesothelioma is that it improves patient survival rates.

One study the looked at patients who received neoadjuvant chemotherapy, EPP and then adjuvant hemithoracic radiotherapy—radiation therapy that is focused on one side of the chest. The study found that the median survival rate (the length of time where half of the patients in the study are still alive) was 29 months.

However, survival rates will differ from person to person and case to case. Some of the factors that influence are the patient’s age, gender, overall health, smoking habits and cancer stage.

Trimodal Therapies Are Tailored to Each Patient

Because each patient and case of mesothelioma is different and unique, the type of trimodal treatment that works for one patient might not work for another patient. Adjuvant therapies might not be very beneficial if the cancer is in an early stage and has not yet spread. However, the more the tumor has spread, the more helpful adjuvant and neoadjuvant therapies become.

Other considerations would be a patient’s overall health and treatment side effects. Doctors also consider how side effects could impact the patient’s ability to work or stay active and the likelihood of the patient remaining cancer-free.

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Sources
  1. Mayo Clinic Staff. “Adjuvant therapy: Treatment to keep cancer from returning.” 2018. Retrieved from:  https://www.mayoclinic.org/diseases-conditions/cancer/in-depth/adjuvant-therapy/art-20046687. Accessed May 4, 2018.
  2. Tan, Winston W. “Mesothelioma Treatment & Management.” 2017. Retrieved from: https://emedicine.medscape.com/article/280367-treatment#d1. Accessed May 4, 2018.
  3. Weder, Walter & Isabelle Opitz. “Multimodality therapy for malignant pleural mesothelioma.” Annals of Cardiothoracic Surgery. Nov 2012, 1 (4) 502-507. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741801/. Accessed May 8, 2018.

Last modified: October 24, 2018