The Italian case report comes on the heels of study earlier this summer at Memorial Sloan Kettering in New York that called IMRT part of a “new lung-sparing paradigm” in multimodality therapy for patients with locally advanced pleural mesothelioma.
This week, radiotherapy researchers in Italy released a case report on a pleural mesothelioma patient who has experienced 14 months of progression-free mesothelioma survival after IMRT.
IMRT for Mesothelioma
IMRT (Intensity Modulated Radiotherapy) is a form of radiotherapy that allows radiologists to precisely deliver radiation in a shape that conforms to the shape of a mesothelioma tumor.
This is critical for patients with mesothelioma because mesothelioma tumors, which grow on the pleural membrane, tend to be irregularly shaped, making them extremely challenging to treat with less conformal radiotherapy techniques.
In addition, mesothelioma tumors are typically situated adjacent to critical organs like the lungs and heart. Any radiotherapy plan has to take into account the need to protect these tissues from radiation damage.
Promising Mesothelioma Case Report
In the new Italian case report, doctors detail their treatment of a 73-year-old mesothelioma patient who had experienced a relapse of his mesothelioma 10 months after radical lung-removing mesothelioma surgery and chemotherapy.
Using an Elekta XiO treatment planning system, his doctors were able to create a patient-specific treatment plan to safely deliver a lethal dose of 5000 Gy into his mesothelioma tumor without harming surrounding organs.
The patient experienced no serious side effects from the high dose of radiation and is still alive 32 months after his mesothelioma diagnosis.
Cautious Optimism for Mesothelioma Treatment
Although the results of this mesothelioma case report are promising, the authors of the report published in the journal Future Oncology say it is still too soon to offer IMRT as a regular part of mesothelioma treatment.
They point to other studies in which mesothelioma patients treated with IMRT have experienced serious side effects and even died from the effects of the radiation. In addition, a large 2014 study of IMRT for mesothelioma after surgery and chemotherapy found no survival benefit or improved disease control.
“For these reasons, currently the use of IMRT must be limited to clinical trials, especially in [the] adjuvant setting after EPP, where more prospective studies are needed to determine the safe dose levels to be respected,” concludes lead author, Dr. Corrado Spatola, with the University of Catania.
Although the role of IMRT in mesothelioma treatment is still unclear, the report acknowledges that IMRT already plays a valuable role in palliative care and pain control in cases of relapsed mesothelioma.
Spatola, C, et al, “Intensity-modulated radiotherapy for relapsed malignant pleural mesothelioma.”, September 21, 2016, Future Oncology, Epub ahead of print