A new study says there is not enough evidence to support the use of radiotherapy for the treatment of pain associated with malignant pleural mesothelioma.
Researchers at the University of Edinburgh in Scotland reviewed a range of past studies on mesothelioma pain and radiotherapy by searching databases that date back as far as 1974. To be eligible to be included in their review, the study had to focus on malignant pleural mesothelioma and radiotherapy given “with the intent of improving pain”. The study also had to report doses and fractionation of the radiotherapy and how the pain responded.
In all, the researchers found eight studies on mesothelioma pain and radiotherapy that met the criteria. Two of the studies were prospective Phase II studies while the rest were retrospective (looking back on past cases). Unfortunately, the Scottish research team concluded that the studies were two different from each other to draw any solid conclusions about the efficacy of radiotherapy for mesothelioma pain.
Writing on their findings in the journal Lung Cancer, they conclude, “Due to marked heterogeneity among studies, quantitative synthesis of results was not possible. No high quality evidence currently exists to support radiotherapy in treating pain in malignant pleural mesothelioma.”
The findings do not mean that radiotherapy cannot help relieve mesothelioma pain. In fact, several decades of studies on mesothelioma radiotherapy have found that, by reducing the size of tumors, RT does sometimes help relieve pressure on the lungs and chest, reducing pain and making it easier for the patient to breathe, although the effects are usually short-lived.
But the new study does point to the need for better and more clearly-defined research on mesothelioma pain relief with radiotherapy. The researchers say these studies should use modern radiotherapy techniques and focus on “clear pain endpoints” in order to provide a clearer picture of the efficacy of the technique and best dosing strategies. The Scottish team says better-designed, more homogenous studies will allow clinicians to use radiotherapy more effectively to reduce mesothelioma pain.
Macleod, N, et al, “Radiotherapy for the treatment of pain in malignant pleural mesothelioma: A systematic review”, November 14, 2013, Lung Cancer, Epub ahead of print.