NCCN Guidelines for Patients® | Malignant Pleural Mesothelioma - page 33

31
NCCN Guidelines for Patients
®
Malignant Pleural Mesothelioma, Version 1.2014
5
Treatment guide
Stage I–III epithelioid or mixed mesothelioma
Neoadjuvant treatment
You can receive chemotherapy either before or after
surgery. Chemotherapy given before surgery is called
neoadjuvant treatment. It is given to shrink the tumor
before it is removed from the body. Pemetrexed with
cisplatin is recommended for neoadjuvant treatment.
Chemotherapy is the use of drugs to treat cancer.
Chemotherapy drugs kill fast-growing cells. Cancer
cells grow fast, so chemotherapy works well to stop
new cancer cells from being made. However, it
also kills normal cells and can cause side effects.
Side effects are unplanned physical or emotional
responses to treatment. Ask your doctor for a list of
side effects caused by chemotherapy.
Chemotherapy is given in cycles of treatment days
followed by days of rest. Cycles give the body a
chance to recover before the next treatment. The
length of 1 cycle of pemetrexed and cisplatin is 21
days. Pemetrexed and cisplatin are given on Day 1
of the cycle. Both drugs are liquids that are slowly
injected into your vein.
Follow-up
If you receive neoadjuvant treatment, a CT scan
of your chest is recommended to check treatment
results. The CT scan can show if the tumor is smaller
and where it is still present. See page 15 for more
information on CT scans. Based on the results of the
chest CT, your doctors may want you to have another
imaging test to assess if there’s cancer in the area
between your lungs.
Neoadjuvant
treatment
Surgical
exploration
Primary
treatment
Adjuvant
treatment
Surgery is possible
P/D (
p
leurectomy/
d
ecortication)
None
Chemotherapy
EPP (
e
xtra
p
leural
p
neumonectomy)
Radiation therapy
Surgery is
not possible
Chemotherapy
Surgery is possible
P/D (
p
leurectomy/
d
ecortication)
Chemotherapy
None
EPP (
e
xtra
p
leural
p
neumonectomy)
Sequential
chemotherapy +
radiation therapy
Surgery is
not possible
Chemotherapy
Stage I–III epithelioid or mixed mesothelioma: Treatment with surgery
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