The largest study ever conducted on adjuvant radiotherapy for mesothelioma shows that it can help patients live longer.
Pleural mesothelioma is a rare cancer that tends to be highly resistant to standard treatments. Doctors usually have to use a combination of treatments to attack it. These may include chemotherapy, radiotherapy, surgery, and/or immunotherapy.
But there are still many questions about what combination of therapies to use and in what order.
Adjuvant radiotherapy for mesothelioma is radiation delivered prior to surgery. Now, radiation oncology researchers in Texas say this approach can extend mesothelioma survival.
Killing Mesothelioma Cells with Radiation
Mesothelioma cells are hard to kill. Chemotherapy with Alimta (pemetrexed) and cisplatin is the most common treatment. But mesothelioma tumors usually start to grow again within a few months after treatment.
Surgery is another option. But if even a few mesothelioma cells are left behind, they can quickly turn into new tumors. Adjuvant radiotherapy for mesothelioma can disrupt the DNA inside those cells. Cells with scrambled DNA are unable to divide and multiply.
Radiotherapy can also be delivered before surgery to shrink a tumor. This is called neoadjuvant radiotherapy. It can also help alleviate some types of mesothelioma symptoms.
Although it is not usually the primary treatment for pleural mesothelioma, radiotherapy can help make other types of treatment more effective.
Evaluating Adjuvant Radiotherapy for Mesothelioma
Mesothelioma patients diagnosed between 2004 and 2013 were divided into three groups. One group received no treatment, one group received only surgery, and the third group got surgery followed by radiotherapy.
“Overall, the surgery plus radiotherapy group had a higher median survival (21.4 months) compared with surgery alone (16.59 months),” writes lead author Gary Lewis, MD.
Adjuvant radiotherapy for mesothelioma was most common after EPP surgery. EPP is the most radical and extensive type of mesothelioma surgery. Patients who underwent lung-sparing PD surgery were less likely to have adjuvant radiotherapy.
This retrospective (looking at past cases) study is the largest ever conducted on adjuvant radiotherapy for mesothelioma. The research team is calling for more prospective (following patients in real time) data to confirm these results.
Lewis, GD, et al, “The Role of Adjuvant Radiotherapy in the Treatment of Pleural Mesothelioma”, February 24, 2019, Annals of Surgical Oncology, Epub ahead of print, https://link.springer.com/article/10.1245%2Fs10434-019-07235-9