Advanced multimodal protocols are used at the Ichilov clinic for the treatment of aggressive pericardial mesothelioma: 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 tumor, 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 resolving all everyday issues. This 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 tumor 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
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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 tumor, 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 tumor 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 tumor masses as completely as possible, including affected areas of the pericardium and adjacent structures if necessary. At Ichilov, video thoracoscopic technologies are used to visualize the surgical field at multiple magnifications through minimal access, 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 the removal of the main tumor mass, while the surgical cavity is still open, oncologists perform a procedure of local exposure using heated chemotherapy agents on residual microscopic foci. A solution heated to 42-43 degrees circulates in the pericardial area for a specified time, destroying malignant cells that cannot be removed with a scalpel. Hyperthermia enhances the penetration of cytostatics into tissues and increases the sensitivity of tumor elements to chemical exposure. This method is especially valuable in mesothelioma, which tends to microscopically spread along serous membranes, significantly reducing the risk of local recurrence in the months following surgery.
Systemic Chemotherapy
In stages when the tumor 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 tumor resistance. Modern regimens include the addition of agents that protect healthy tissues from toxic effects and precise dose calculations based on body surface area and kidney function.
Targeted Therapy
Molecular profiling of tumor 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 tumor, 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 treatment courses.
Immunotherapy
When standard approaches have exhausted their potential or the tumor initially demonstrates aggressive behavior, drugs that activate the patient's own immune system against cancer cells come into play. Immune checkpoint inhibitors remove the blockade from T-lymphocytes, allowing them to recognize and destroy tumor 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 cells. The response to immunotherapy may develop gradually, but when an effect is achieved, it often proves to be long-lasting and stable, providing disease control for many months.
Radiation Therapy
Radiation exposure is used to control local manifestations of the tumor, 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 dose fields to be formed with sub-millimeter precision, concentrating radiation on tumor tissue while sparing 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 high ablative doses to be delivered in a minimal number of sessions. Planning is based on four-dimensional CT data considering respiratory movements, ensuring accuracy even in moving targets.
Pericardiocentesis and Drainage
The accumulation of fluid in the pericardial cavity due to the tumor 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 pericardial layers to adhere and preventing re-accumulation of fluid.
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 tumor 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 impact on thin tumor 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 surgery
- Radiation therapy
- Chemotherapy
Diagnostic Methods for the Disease
The diagnosis of pericardial mesothelioma requires maximum accuracy and high speed due to the rare and aggressive nature of the disease. This pathology often masquerades as common 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.
Day One
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.
Day Two
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
- Computed tomography (CT) of the chest with contrast
- Magnetic resonance imaging (MRI) of the heart
- Positron emission tomography/CT (PET/CT)
- Pericardiocentesis with cytology of the effusion
- Pericardial biopsy (needle or open under imaging guidance)
- Immunohistochemical examination of the biopsy
Day Three
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
What is the Cost of Treatment in Israel
The total 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 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 tumor 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 the medical documents and examination results. As a result, an expert opinion on the diagnosis, recommendations for the optimal treatment strategy, answers to pressing questions, and information about available modern technologies relevant to the specific situation can be obtained.