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24

NCCN Guidelines for Patients

®

:

Malignant Pleural Mesothelioma, Version 1.2016

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 with contrast dye is recommended to

check treatment results. The CT scan can show if

the tumor is smaller and where it is still present. See

page 14 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. Another

imaging test could be a PET/CT scan. This depends

on the results of the chest CT.

Primary treatment

Primary treatment is the main treatment used to rid

your body of cancer. Surgery is used as a primary

treatment for some mesotheliomas.

Guide 7. Treatment options

Neoadjuvant

treatment

Is surgery

possible?

Primary treatment

Adjuvant treatment

Chemotherapy

ª

Yes

ª

P/D (

p

leurectomy/

d

ecortication)

ª

None

EPP (

e

xtra

p

leural

p

neumonectomy)

ª ª

Radiation therapy

ª

No

ª

Chemotherapy

None

ª

Yes

ª

P/D (

p

leurectomy/

d

ecortication)

ª

Chemotherapy

ª

EPP (

e

xtra

p

leural

p

neumonectomy)

ª

Sequential chemotherapy

+ radiation therapy

ª

No

ª

Chemotherapy

4

Treatment guide

Stage I–III epithelioid or mixed mesothelioma