• Best outcomes worldwide

    We offer a personalised service based on the best available therapies and pride ourselves on providing the highest level of care and most innovative treatments.

  • Best outcomes worldwide

    We offer a personalised service based on the best available therapies and pride ourselves on providing the highest level of care and most innovative treatments.

  • Best outcomes worldwide

    We offer a personalised service based on the best available therapies. We pride ourselves on providing the highest level of care and most innovative treatments.

Best outcomes worldwide

We offer a personalised service based on the best available therapies and pride ourselves on providing the highest level of care and most innovative treatments.

Best outcomes worldwide

We offer a personalised service based on the best available therapies and pride ourselves on providing the highest level of care and most innovative treatments.

Best outcomes worldwide

We offer a personalised service based on the best available therapies. We pride ourselves on providing the highest level of care and most innovative treatments.

London Mesothelioma clinic

The London Mesothelioma Clinic is at The Lister Hospital in Chelsea. We offer the full range of diagnostic procedures and therapies for mesothelioma. We specialise in pain management and nutrition for our patients. London Mesothelioma Clinic provides access to clinical trials, new drugs through the Sarah Cannon Centre, state of the art imaging facilities, modern and comfortable rooms, a new intensive care unit and chemotherapy and radiotherapy facilities: we offer the best and most advanced mesothelioma treatments.

Mesothelioma is a malignant tumour involving the pleura (lining of lung), induced by asbestos exposure in most cases. There is generally a long latency between the asbestos exposure and diagnosis. More than 2,400 mesothelioma deaths are registered each year in the UK. Hundreds of thousands of lives will be claimed in Europe during the next 50 years as a result of the asbestos legacy.

The London Mesothelioma Clinic offers a multi-disciplinary approach to mesothelioma treatment. It is our belief that every mesothelioma patient should be offered the opportunity to discuss all available therapies and to make an informed decision after receiving the best recommendation from our team.

As the only dedicated mesothelioma clinic in Europe, we are open to various invasive and non-invasive therapies whilst utilising the most innovative technology.

We only work with experts in the field, most have more than 15 years of experience in the field of mesothelioma therapy.

Clinic contacts

The Lister Hospital
Chelsea Bridge Road
London SW1W 8RH

Appointments

t: 020 3553 1549

Switchboard

t: 020 7730 7733

Email

e: lang-lazdunski@hcaconsultant.co.uk

Meet the team

Mesothelioma Treatments


There is no known cure for mesothelioma, but some treatments can improve symptoms and prolong life significantly. Research in the field is progressing and new drugs become available regularly as part of clinical trials.

Surgery plays an essential role in diagnosing mesothelioma, staging the cancer, and may play an essential part in multi-modality therapy in combination with chemotherapy, immunotherapy, and radiotherapy.

Chemotherapy

Mesothelioma is considered a chemo-resistant tumour. Thus, most mesothelioma cells have deficient molecular machinery, allowing them to survive chemotherapy. The best chemotherapy combinations for mesothelioma treatment seem to be with drugs belonging to the anti-folate family (pemetrexed and raltitrexed) with a platinum salt (cisplatin or carboplatin). Approximately four out of 10 patients respond to chemotherapy. Other chemotherapy drugs are commonly used in mesothelioma such as gemcitabine, vinorelbin, irinotecan, doxorubicin. Those drugs can cause serious side effects and significantly impair a patient’s quality of life. Chemotherapy cannot cure mesothelioma, but it can prolong life by months or years. Patients can receive several courses of chemotherapy, depending upon tolerance and response to treatment. The same drug can be used in case of good response. Alternatively, another drug can be offered if the first drug proved inefficient. Chemotherapy can be used in combination with surgery and radiotherapy to treat mesothelioma – this type of treatment is referred to as multi-modality therapy.

Radiotherapy

Radiotherapy is often used in mesothelioma treatment. It can control severe pain due to invasion of bones (ribs or spine) by the tumour. Radiotherapy is often used to prevent the growth of a tumour in a needle tract or port site following a tumour biopsy. A large trial is currently taking place in the UK to confirm the usefulness of radiotherapy in this indication (PIT trial). Radiotherapy is sometimes used to prevent tumour relapse after surgical removal. In this case it is called adjuvant radiotherapy. Radiotherapy treatments usually last from a few days to a few weeks and patients do not have to be admitted into hospital for this.

Conventional radiotherapy can be used, but this will usually cause collateral damage to the lung (radiation pneumonitis), to the oesophagus (oesophagitis) and possibly to other surrounding organs / structures (liver, stomach, kidney, spinal cord). A few years ago, doctors introduced a new radiotherapy technique named IMRT for intensity-modulated radiotherapy. This technique allows for more doses to be delivered to the mesothelioma tumour and less to be delivered to the surrounding organs/structures. This technique is presently being evaluated in several studies, but at present there is no evidence that it does improve mesothelioma tumour control.

Immunotherapy

Immunotherapy is a form of treatment that aims at boosting the immune system to attack the mesothelioma tumour. It relies either on agents or drugs that will attack the tumour directly by targeting key signals on malignant mesothelioma cells, or on agents or drugs that will cause the patient's own immune system (patients cells or/and antibodies) to attack and destroy the tumour. Immunotherapy trials have been performed for more than five decades in mesothelioma treatment, with an injection of BCG directly into the tumour, to most sophisticated gene-therapy delivered directly inside the chest cavity to neutralise and destroy tumour cells. Although some experiences have been positive, it is fair to say that immunotherapy usually works in patients with early-stage mesothelioma, but provides a limited life expectancy. At present, doctors are trying to combine immunotherapy with chemotherapy, radiotherapy or surgery to maximise the therapeutic response, offering a prolonged disease-free period by trying to immunise the patient against the tumour (an effect similar to a vaccination against a virus). Recent experiences in mesothelioma patients have proven that it is possible to induce the formation of antibodies directed towards tumour antigens by patients receiving immunotherapy. The future will show if this is enough to contain the tumour durably.

Surgery

Surgery can be offered in mesothelioma treatment to establish a diagnosis (pleural biopsy), drain the fluid accumulated in the chest cavity and prevent its re-accumulation (pleurodesis), appreciate the extent of the tumour (staging), or remove the tumour (radical surgery).

Major and minor surgeries

Minor diagnostic surgery for mesothelioma can be performed under local anaesthetic with some IV sedation; major surgery is always performed under general anaesthesia in a surgical theatre.

Minor surgery is usually performed by thoracic surgeons, but experienced chest physicians do perform medical thoracoscopy in specialist centres. Keyhole surgery (thoracoscopy or VATS) involves making one inch incisions over the rib cage and introducing a camera inside the chest to visualise the pleura, inspect the lung, diaphragm, oesophagus, heart and vessels. Pleural biopsies are taken under direct vision. If fluid has accumulated in the cavity (pleural effusion) it will be drained during the same procedure and sent for analysis (cytology). Often, the surgeon will perform a pleurodesis at the same time to prevent fluid re-accumulation: sterile talcum powder, iodine or chemotherapy agents can be injected into the chest cavity to cause inflammation and obliterate the space between the lung and the rib cage. Rarely, the pleura can be removed surgically to allow for a full expansion of the lung (pleurectomy).

Patients are usually admitted to the Lister Hospital for a few days for a pleurodesis and can expect to make a full recovery within four weeks.

In cases where the lung is trapped by the mesothelioma tumour and no lung re-expansion can be obtained, the surgeon can place an indwelling catheter in the chest cavity, which can be used daily to withdraw fluid from the cavity and relieve breathlessness. Fluid withdrawal can be done at home, usually with the help of a nurse.

Over the years, two main surgical procedures have been used to remove malignant pleural mesothelioma: extrapleural pneumonectomy (EPP) and pleurectomy / decortication (P/D). Both procedures have been performed for five decades at expert centres.

EPP is a major procedure where the all pleural tumour is removed together with the all lung, hemi-diaphragm and percardium (sac around the heart). The operation takes four to eight hours and patients are usually in hospital for two weeks postoperatively. A minimum of six to eight weeks’ recuperation is required after EPP.

Pleurectomy / decortication (P/D) is an alternative procedure where all the tumour around the lung is removed, but where the lung is spared and the diaphragm is spared in the majority of cases. The procedure takes around 4-6 hours and is usually well tolerated. The hospital mortality and complication rate are much lower after P/D. This procedure can be combined with chemotherapy, before or after.

Outcomes

Professor Loic Lang-Lazdunski, from London Mesothelioma Clinic, reported his 10-year experience of a multi-modality regimen involving radical pleurectomy and hyperthermic pleural lavage with povidone-iodine, together with systemic chemotherapy, at the annual meeting of the American Association of Thoracic Surgery in Toronto in April 2014.

In more than 100 operations, no mortality occurred and there was a median overall survival of 32 months - one of the best ever reported in the field. He showed that the cell sub-type was a very important prognostic factor; patients with Epithelioid Mesothelioma lived significantly longer (median survival over 35 months) than those with biphasic or sarcomatoid sub-type (median survival 15 months) following multi-modality therapy.

After five years, more than a third of patients with Epithelioid Mesothelioma were alive. Another important finding in that study was that complete macroscopic resection was significantly associated with survival: patients in whom the surgeon could remove all visible tumours lived longer than those who had any tumour left behind. This is a very important point as mesothelioma surgery is demanding and there is a long learning curve.

Survival curve (Kaplan-Meier Method) Showing increased survival following removal of tumour Survival-based-on-CMRIt has been shown by others that mortality, complication rates, and survival are better centres, dealing with a large number of mesothelioma operations. Professor Loic Lang-Lazdunski and colleagues showed the role and importance of PET-CT in the diagnosis, prognosis and follow-up of malignant pleural mesothelioma. He was the first to report the use of Cyberknife, a relatively new stereotactic radiotherapy tool, in malignant pleural mesothelioma.

Our London Mesothelioma Clinic team based at The Lister Hospital Chelsea, currently has the best outcomes worldwide, with more than one in three patients with epithelioid mesothelioma alive beyond five years.

Meet the team

Clinic contacts

The Lister Hospital
Chelsea Bridge Road
London SW1W 8RH

Appointments

t: 020 3553 1549

Switchboard

t: 020 7730 7733

Email

e: lang-lazdunski@hcaconsultant.co.uk

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