Treatment Side Effects

The most important thing to keep in mind about mesothelioma treatment side effects is that you should monitor them to be sure that they don’t increase in severity. Any change in side effects should be immediately reported to your doctor.

Study Discusses Complications after Extrapleural Pneumonectomy

There is risk for complications with any surgery; however, since extrapleural pneumonectomy is an extremely complex procedure, the rate of incidence is higher.

In a study titledRisk Factors for Major Complications After Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma, published April 2008 in The Annals of Thoracic Surgery, researchers examined 62 patients who underwent extrapleural pneumonectomy for malignant pleural mesothelioma between January 1993 and May 2007.

Their observations led them to conclude that patients who experienced major complications were older, meaning 60+ years as compared with patients who were 56 years or younger. The amount of transfused red blood cells also affected risk for complication. Those who receive more than four units were at increased risk. Finally, major complications occurred in 54 percent of the procedures performed on the right side as compared with 21 percent performed on the left. As with mesothelioma in general, being male and having late stage cancer also increased the odds.

Complications were considered to be a result of surgery if they occurred within 30 days of the procedure or during the same hospital stay. Major complications were defined as complications of grade 3 or higher according to the National Cancer Institute Common Terminology Criteria for Adverse Events 3.0 guidelines. They included:

  • Atrial fibrillation (irregular heart beat)
  • Cardiac arrest
  • Pulmonary emboli (obstruction that causes a blood clot in the lungs)
  • Acute lung injury/pneumonia
  • Abdominal herniation
  • Esophageal perforation

Malignant Seeding Can be an Adverse Effect of Surgery

A condition called “seeding” is a common result of surgeries used for diagnosis, tumor staging and talc pleurodesis. Malignant cells grow in the tracts created during thoracentesis, a procedure that uses a puncture through the chest wall either to take a sample of pleural fluid to diagnosis its cause, or to relieve shortness of breath. It can also be used for talc pleurodesis. These malignant cells can also grow in biopsy sites, chest tube sites and surgical incisions.

According to the authors of Malignant Mesothelioma: Advances in Pathogenesis, Diagnosis and Translational Therapies, “The frequency of malignant seeding, has been reported to occur in approximately 20% to 50% of mesothelioma patients who undergo these procedures.” It typically presents as painful nodules below the skin and is treated with radiation.

In a study titled Prevention of malignant seeding at drain sites after invasive procedures (surgery and/or thoracoscopy) by hypofractionated radiotherapy in patients with pleural mesothelioma, published 2008 in Acta Oncologia, researchers tracked 32 patients diagnosed with pleural mesothelioma who underwent surgery and/or thoroscopy (procedure that uses an endoscope to see inside the chest) for diagnosis, staging or talc pleurodesis. They were treated with external beam radiation therapy at a dose of 21 Gy (gray) in 3 fractions over one week, meaning the treatment was spread out over three sessions that took place during the same week. After completion of radiation treatment, 20 of 32 patients underwent chemotherapy.

The researchers observed that after an average follow-up of 13.6 months from the end of radiation therapy, no patient experienced disease progression in the treated area. Seventeen patients died of disease that had progressed locally after an average survival time of 12.6 months; 13 patients were alive with disease after an average follow-up of 13.9 months; 2 patients were alive without evidence of disease after an average follow-up of 16.5 months.

Radiation Side Effects

The American Cancer Web site sys this about adverse effects caused by radiation:

“Side effects of radiation therapy may include fatigue and mild skin changes that resemble sunburn. These usually go away once treatment is finished. Chest radiation therapy may cause lung damage and lead to trouble breathing and shortness of breath. Abdominal radiation therapy may cause nausea, vomiting, diarrhea, and a loss of appetite.

If radiation therapy is used together with chemotherapy, it may make the side effects of chemotherapy worse.

If you are having any side effects from radiation therapy, talk with your doctor. In most cases there are ways to help control these symptoms.”

For specifics about radiation and its side effects, visit cancer.org

Chemotherapy Side Effects

The standard combination of chemotherapy drugs used to treat mesothelioma is cisplatin (Platinol) and pemetrexed (Alimta). If the patient is unable to tolerate cisplatin, carboplatin, a chemotherapeutic agent from the same drug class, is substituted.

In a study titledRandomized phase II trial of pemetrexed combined with either cisplatin or carboplatin in untreated extensive-stage small-cell lung cancer, published October 20, 2006 in the Journal of Clinical Oncology, researchers evaluated 78 patients enrolled in this clinical trail from December 2002 to May 2004.The patients were randomly assigned to receive either cisplatin/pemetrexed (average age of patients in this group was 63 years old) or carboplatin/pemetrexed (average age of patients in this group was 66 years old).

The chart below lists the type of adverse effect and the percentage of patients who experienced it broken down by drug combination:

Cisplatin/pemetrexed

  • Anemia – 10.5 percent
  • Neutropenia (low white blood cell count) – 15.8 percent
  • Thrombocytopenia (low platelet count) – 13.2 percent
  • Shortness of breath – 5.3 percent
  • Nausea – 15.8 percent
  • Vomiting – 7.9 percent
  • Nervous system toxicity – 15.8 percent
  • Diarrhea – 2.6 percent
  • Fatigue – 10.5 percent

Carboplatin/pemetrexed

  • Anemia – 5.7 percent
  • Neutropenia – 20 percent
  • Thrombocytopenia – 22.9 percent
  • Shortness of breath – 20 percent
  • Nausea – 14.3 percent
  • Vomiting – 14.3 Percent
  • Nervous system toxicity – 2.9 percent
  • Diarrhea – 2.9 percent
  • Fatigue – none

Mucositis (inflammation and sores on the mouth and the mucous membrane lining the gastrointestinal tract) and skin rash were rare, occurring in less than 10 percent of patients.

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