In addition to chemotherapy, radiation therapy, and immunotherapy, those suffering from mesothelioma also have the option for surgery (if they are physically able). Surgery is one of the better options for mesothelioma patients because it can remove most if not all the cancer; however, often times since the cancer is generally diagnosed in the later stages of the disease, the cancer has spread too much and the patient is weak, so surgery is not a viable option. Mesothelioma tumors grow quickly, and are also irregularly shaped so it can be difficult to remove them completely. Additionally, because of the nature of the disease, PET and CT scans are not always accurate in distinguishing between benign and cancerous protuberances in the lung. This is why despite surgical procedures the cancer is still able to spread.
However, a new surgical technique called Near-Infrared Intraoperative Imaging (NIR) using TumorGlow® aims to change how mesothelioma tumors are detected, and ultimately removed. TumorGlow® is a type of injectable dye that is specifically designed to be attracted to cancerous tissue. When the dye is administered before surgery, it builds up around the malignancies. Once the procedure is underway, surgeons utilize near- infrared light to illuminate the smaller clusters of cancer cells that were initially unable to be detected with traditional imaging methods.
A recent study published in The Annals of Thoracic Surgery notes the success of NIR and TumorGlow® after an open label clinical trial that involved 20 mesothelioma patients who were scheduled to either have a pleural biopsy or a pleurectomy with decortication (P/D). Before their procedures, TumorGlow® was administered in each patient. With the infrared light doctors and surgeons were able to collect 203 specimens to submit for further review. It was then determined that out of the 203 specimens collected, 113 of the samples contained mesothelioma tumors. Those 113 samples also had the highest levels of the dye. The study concluded that the NIR technique along with TumorGlow® administration could potentially increase the chances of mesothelioma tumors being detected; even the smaller ones typically missed by PET and CT scans.
There are several surgical procedures to treat mesothelioma. Some mesothelioma surgeries aim to provide a curative effect, while others are performed for palliative purposes (to reduce pain and other symptoms affecting a patient). They key to any successful surgery involving cancer is to not only find the cancerous tumors, but to remove them entirely. Removing the cancer completely increases the chance that cancer will not return, but since mesothelioma tumors are difficult to completely remove, surgery is often used in conjunction with other treatments.
Predina, Jarrod, et. al. “A Clinical Trial of TumorGlow® to Identify Residual Disease during Pleurectomy and Decortication” Annals of Thoracic Surgery (July 17, 2018). [Link]