Aggressive medical cancer treatment includes surgery, chemotherapy, and/or radiation.

• Surgery
  There are several medical centers in the U.S. where thoracic surgeons with special training and facilities perform a major, radical surgery called extrapleural pneumonectomy. During this surgery, the entire pleura (a thin sac surrounding the lung) and lung on the affected side are removed. Frequently, the diaphragm and pericardium (the lining around the heart) on the affected side are also removed. Synthetic materials are then used to reconstruct the diaphragm, primarily to keep the content of the chest separate from the abdomen.

• Chemotherapy
  There appears to be little evidence that currently available chemotherapeutic agents without surgery have any real effect on mesothelioma. Therefore, chemotherapy is usually administered after an extrapleural pneumonectomy. People may have very strong adverse side effects to chemotherapy. There are some people who do have, at least for a period, a positive response to chemotherapy.

• Radiation
  Radiation treatments may also be given as a follow-up treatment to the radical surgery. As with chemotherapy, there is little evidence that radiation alone has any real benefit in prolonging life or quality of life in mesothelioma patients. Some people may have significant adverse side effects to radiation treatment.

Factors to consider with these treatments include:

• Recuperation and quality of life
  Extrapleural pneumonectomy (the surgery for mesothelioma treatment) is serious. Patients who have this surgery sometimes take up to a year (if they survive that long) to recover from the surgery. Therefore, there are significant quality-of-life issues that a patient should consider before agreeing to this surgery, if the surgery is an available option. In addition, the chemotherapy and radiation treatment administered after the surgery may cause some patients to feel extremely sick while they are receiving treatments.

• Availability
  The pioneering work in aggressive mesothelioma treatment was done by a surgeon working in Boston. The treatment is only available in major medical centers and teaching hospitals. Surgeons offering this type of treatment carefully select patients for the treatment. Age, overall health, and extent of spread (the 'stage') of the mesothelioma are factors that surgeons and oncologists evaluate when selecting candidates for the surgery.

• Cost
  The surgery and follow-up treatment is very expensive. The cost includes fees for the physician, significant periods of hospitalization, chemotherapy, and radiation treatments. If the patient and any family members or friends must travel long distances to reach a facility where the treatment is provided, they incur the additional expenses of airfare, lodging, and related travel expenses. We have seen the medical expenses associated with this type of treatment exceed $150,000. Cost varies depending on where the treatment is provided; it is an expensive course of treatment wherever it is provided.
  

Some patients decline these treatments because of the high cost; pain and discomfort of surgery, chemotherapy, and radiation; and the negative impact on the quality of their lives. Other patients feel the treatment is a chance they must take.