When malignant pleural mesothelioma patients receive radiation therapy in the form of IMRT (intensity modulated radiation therapy) at an experienced institution, the treatment can be both feasible and effective.
That is the conclusion of Dr. Kenneth Rosenzweig, Chairman of the Department of Radiation Oncology at Mount Sinai School of Medicine in New York. Rosenzweig is the author of a new summary of radiation therapy in the treatment of pleural mesothelioma published in a recent issue of the Annals of Translational Medicine.
The Evolution of Radiation Therapy for Mesothelioma
Radiotherapy involves sending high doses of radiation into cancer cells with the goal of damaging their DNA so that it is harder for them to replicate and form tumors.
Although radiotherapy has become increasingly important in mesothelioma treatment, its benefits have never been proven for this cancer. In fact, as Dr. Rosenzweig acknowledges, some early studies indicated that radiotherapy for mesothelioma could cause fatal toxicity.
But IMRT and experience have changed the outlook for people with pleural mesothelioma. IMRT offers a way to conform beams of radiation to the size and shape of a mesothelioma tumor, minimizing the toxicity to healthy surrounding tissue.
As more institutions have gotten better at using this tool, mesothelioma outcomes have improved.
Radiation and Mesothelioma Surgery
As the thinking about mesothelioma surgery has evolved, the way radiotherapy is used in this cancer has also had to evolve.
As Dr. Rosenzweig observes, because of the complications associated with extrapleural pneumonectomy (EPP) surgery, more mesothelioma patients are undergoing lung-sparing P/D surgery instead.
“Therefore, radiation oncologists will be evaluating patients with two intact lungs in need of adjuvant radiation therapy,” writes Dr. Rosenzweig. “IMRT, with its ability to deliver concave doses of RT to complex geometries, is a logical solution to this problem.”
Although treatment planning for IMRT is highly complex, and people with mesothelioma tumors tend to have multiple health problems, as experience with IMRT has increased, pleural mesothelioma outcomes have steadily improved.
“It now appears that RT, particularly with IMRT, is both feasible and effective,” concludes Rosenzweig.
Rosenzweig, K, “Malignant pleural mesothelioma: adjuvant therapy with radiation therapy”, June 2017, Annals of Translational Medicine, pp. 242