To treat aggressive pericardial mesothelioma at the Ichilov Clinic, advanced multimodal protocols are used: from video-assisted surgery and intraoperative chemotherapy to targeted and immunotherapy. World-class experts determine the strategy at consultations based on the molecular-genetic profile of the tumour, allowing for results even in the most complex clinical cases.
At the patient's request, a personal companion or assistant can be involved in the treatment, who takes full responsibility for coordinating the process and solving all everyday issues. Such individual support at every stage, combined with comfortable accommodation conditions, allows the patient to focus entirely on recovery without being distracted by organizational tasks.
About the Disease
Pericardial mesothelioma is a rare malignant tumour arising from the mesothelial cells of the pericardium (the heart's outer sac), accounting for less than 1% of all mesotheliomas.
Causes
- Asbestos exposure (primary, although the link is weaker than in the pleural form)
- Ionizing radiation
- Genetic predisposition
- Viral factors (SV40, controversial)
- Idiopathic cases
Symptoms
- Chest pain
- Shortness of breath
- Pericardial effusion
- Arrhythmias
- Tachycardia
- Hypotension
- Edema
- Cardiac tamponade
- Night sweats
- Weakness
Treatment Methods
At the Ichilov Clinic, the choice of treatment methods for pericardial mesothelioma is based on the results of molecular-genetic analysis of the tumour, the stage of disease progression, assessment of heart function, and the overall condition of the patient using multi-slice CT and PET scanning.
Cytoreductive Surgery
When the tumour is localized and has not spread beyond the pericardial cavity, surgical intervention becomes the cornerstone of the treatment strategy. The operation aims to remove visible tumour masses as completely as possible, including affected areas of the pericardium and, if necessary, adjacent structures. Ichilov uses video-thoracoscopic technologies that allow visualization of the surgical field at multiple magnifications through minimal accesses, reducing trauma and speeding up recovery. Navigation systems help surgeons navigate the complex anatomy of the mediastinum, avoiding damage to coronary vessels and the heart's conduction system.
Intraoperative Hyperthermic Chemotherapy
Immediately after removing the main mass of the tumour, while the surgical cavity is still open, oncologists perform a procedure of local exposure using heated chemotherapy agents on residual microscopic foci. The heated solution, at 42-43 degrees, circulates in the pericardial area for a certain time, destroying malignant cells that cannot be removed with a scalpel. Hyperthermia enhances the penetration of cytostatics into tissues and increases the sensitivity of tumour elements to chemical effects. This method is especially valuable in mesothelioma, prone to microscopic spread along serous membranes, and significantly reduces the risk of local recurrence in the months following surgery.
Systemic Chemotherapy
At stages when the tumour process has spread beyond the pericardium or distant metastases are detected, systemic treatment with drugs circulating throughout the body is required. Ichilov specialists use combinations of cytostatics from different pharmacological groups that act on various mechanisms of cell division, increasing effectiveness and overcoming tumour resistance. Modern regimens include the addition of drugs that protect healthy tissues from toxic effects and precise dose calculations based on body surface area and kidney function.
Targeted Therapy
Molecular profiling of tumour tissue can reveal specific mutations or changes in cell signaling pathways that become targets for targeted action. Drugs from the group of angiogenesis inhibitors block the formation of new vessels that nourish the tumour, depriving it of resources for growth. Other targeted agents act on growth factor receptors or intracellular kinases, which are critical for the survival of malignant mesothelioma cells. Unlike traditional chemotherapy, these molecules act selectively, reducing systemic toxicity and allowing for prolonged courses of treatment.
Immunotherapy
When standard approaches have exhausted their potential or the tumour initially demonstrates aggressive behavior, drugs that activate the patient's immune system against cancer cells come into play. Checkpoint inhibitors remove the blockade from T-lymphocytes, allowing them to recognize and destroy tumour elements that have learned to mask themselves from immune surveillance. This method is particularly promising in mesothelioma with a high mutational burden, where many foreign antigens are presented on the surface of the cells. The response to immunotherapy may develop gradually, but when an effect is achieved, it often proves to be long-lasting and stable, providing control over the disease for many months.
Radiation Therapy
Radiation exposure is used to control local manifestations of the tumour, especially when surgical removal is impossible due to proximity to vital structures or the patient's overall condition. Modern linear accelerators at the clinic allow for the formation of a dose field with sub-millimeter precision, concentrating radiation on the tumour tissue while sparing the surrounding myocardium, lungs, and esophagus. The IMRT technology adapts the intensity of the beam at each point of the irradiated volume, while stereotactic radiosurgery allows for the delivery of high ablative doses in a minimal number of sessions. Planning is based on four-dimensional CT data, taking into account respiratory movements, ensuring accuracy even in moving targets.
Pericardiocentesis and Drainage
The accumulation of fluid in the pericardial cavity due to the tumour process creates compression of the heart and requires urgent intervention to alleviate the condition. Under ultrasound guidance, doctors puncture the pericardium with a thin needle and evacuate the effusion, restoring normal hemodynamics and alleviating shortness of breath. In cases of recurrent fluid accumulation, a drainage system is established, allowing for periodic removal of the exudate without repeated punctures. Sclerosing agents or chemotherapy drugs can be introduced into the cavity, causing the layers of the pericardium to stick together and preventing re-accumulation of effusion.
Photodynamic Therapy
At the stage of intraoperative intervention or during endoscopic procedures, a method based on the activation of photosensitive substances, which accumulate primarily in tumour cells, may be used. A photosensitizer is administered to the patient in advance, which is selectively absorbed by the mesothelioma, and then the surgical field is irradiated with a laser of a specific wavelength. Light energy initiates photochemical reactions, leading to the formation of active oxygen species and the death of malignant elements. This method allows for the targeting of thin tumour layers that are inaccessible for mechanical removal and has minimal toxicity for healthy tissues. The combination of photodynamic therapy with surgery increases the radicality of the intervention and improves local control.
- Cardiac surgeries
- Radiation therapy
- Chemotherapy
Diagnostic Methods for the Disease
Diagnosing pericardial mesothelioma requires maximum accuracy and high speed due to the rare and aggressive nature of the disease. This pathology often masquerades as ordinary cardiological problems, while an accurate diagnosis prevents complications and significantly improves prognosis. The Ichilov Clinic offers patients modern equipment along with an individual approach and extremely short examination times.
First Day
Upon arrival at the Ichilov Clinic, the patient immediately consults with the attending physician. The doctor collects a detailed medical history (complaints, asbestos exposure, heart diseases), conducts an examination with auscultation of the heart and assessment of signs of insufficiency, after which tests are ordered for a complete picture of the condition and confirmation of the diagnosis.
Second Day
On the second day, comprehensive diagnostics are performed, including the following studies:
- Complete blood count
- Biochemical blood analysis
- Biomarker analysis (including mesothelial markers, if available)
- Echocardiography (transthoracic and with contrast if necessary)
- Chest X-ray
- Chest CT with contrast
- Cardiac MRI
- Positron Emission Tomography/CT (PET/CT)
- Pericardiocentesis with cytology of the effusion
- Pericardial biopsy (needle or open under imaging control)
- Immunohistochemical examination of the biopsy
Third Day
On the third day, the attending physician organizes a multidisciplinary consultation involving experts from related specialties – cardiologists, oncologists, radiologists, and thoracic surgeons, where they collectively analyze the results of examinations and the clinical picture. This collegial approach helps avoid possible medical errors, combines the accumulated experience of different specialists, and creates an individual treatment plan ideally suited for the specific clinical case.
- Biomarkers
- Computed Tomography
- Magnetic Resonance Imaging (MRI)
- Diagnosis – PET CT
- Biopsy and histological studies
- Blood biochemistry
- Chest X-ray
How Much Does Treatment Cost in Israel
The final cost of treating pericardial mesothelioma depends on the stage of the disease, the complexity of the operation, and the set of necessary medications. The duration of hospitalization and the volume of diagnostic studies also affect the total amount.
To obtain an accurate estimate with a breakdown of services for your case, please contact the consultant at the phone number listed on the website.
Advantages of Treatment in Israel
- Oncologists with international experience in managing rare mediastinal tumour processes
- Multimodal protocols with intraoperative hyperthermic chemotherapy
- Molecular-genetic profiling for selecting targeted and immunotherapy
- Video-thoracoscopic technologies with minimal tissue trauma
- Comprehensive support at all stages of treatment
Even before arriving in Israel, the patient can order an online consultation with a specialized expert who will review medical documents and examination results. As a result, one can obtain an expert opinion on the diagnosis, recommendations for the optimal treatment strategy, answers to pressing questions, and information about available modern technologies applicable to the specific situation.