New Evidence Supports Post-Surgical IMRT for Mesothelioma Treatment

Just a week after New York researchers published their own study on radiation therapy and mesothelioma surgery, a group of doctors from Texas has reached a similar conclusion – that highly-targeted radiotherapy can improve mesothelioma survival.

This week’s study was conducted by radiation oncology specialists at Austin Cancer Centers and Baylor Scott and White Health in Temple, Texas.

The team performed a retrospective analysis of 18 pleural mesothelioma patients who underwent radical lung-removing mesothelioma surgery between 2005 and 2014. They found that those who had hemithoracic (one sided) intensity modulated radiation therapy (IMRT) lived longer than most people with the asbestos cancer.

Multi-Modality Mesothelioma Treatment

Because malignant mesothelioma is highly resistant to conventional cancer therapies, it usually requires a combination or “multi-modal” treatment approach. Mesothelioma treatments may include (but are not limited to) chemotherapy, radiation therapy, surgery, immunotherapy, cryotherapy, experimental drugs and others.

In their new report published in the Asia-Pacific Journal of Clinical Oncology, the Texas team focused on a controversial mesothelioma surgical approach called extrapleural pneumonectomy (EPP) followed by IMRT. EPP has come under fire in recent years because of the high risk of complications and death associated with removing a lung.

But the new report finds that, in the right patients, IMRT appears to improve mesothelioma outcomes following EPP. Mesothelioma patients in this study had a median overall survival of 38.2 months – more than three times as long as most mesothelioma patients are expected to live. In addition, patients treated with this approach lived a median of 2 years before their mesothelioma tumors began growing again.

Breaking Down the Study Details

The study included 18 mesothelioma patients with a median age of 65. Four of the patients had chemotherapy prior to their EPP surgery and seven underwent chemotherapy afterward. Three patients had Stage I disease, twelve were in Stage III mesothelioma and the remaining three had Stage IV mesothelioma. Most of the patients received 45 Gy of radiation in 25 fractions with a median lung dose of 7.14 Gy.

At a three-year follow-up, eight of the mesothelioma patients in the study (44 percent) were still living.  Just as importantly, while some of the patients did experience side effects such as fatigue, nausea, dermatitis, cough and shortness of breath, none of these symptoms were serious and no one died as a result of the treatment.

Lead researcher and radiation oncologist Sameer Jhavar, MD, PhD, concludes, “Intensity-modulated radiation therapy following EPP for malignant pleural mesothelioma resulted in relapse-free survival and overall survival comparable to the published literature without significant toxicity.”

Just a week earlier, researchers at Memorial Sloan Kettering Cancer Center in New York published their own promising results of using hemithoracic IMRT to treat 78 mesothelioma patients after the lung-sparing surgery pleurectomy with decortication (PD) surgery.

Source:

Jhavar, S, “Intensity modulated radiation therapy after extrapleural pneumonectomy for malignant pleural mesothelioma is feasible without fatal pulmonary toxicity and provides good survival”, Asia-Pacific Journal of Clinical Oncology, March 29, 2017, Epub ahead of print