Hypofractionated radiation for mesothelioma could change how doctors treat this rare cancer.
Researchers in Toronto, Canada have been testing hypofractionated radiation in mesothelioma surgery patients. They have used it to shrink tumors before lung-removing EPP surgery.
Hypofractionated radiation is faster than than standard radiation. It may also cause fewer side effects.
Now, doctors want to know what else this type of radiation might be good for. They plan to test how well hypofractionated radiation works with less radical mesothelioma surgery.
There is also evidence that hypofractionated radiation may strengthen mesothelioma immunotherapy treatment.
Radiation Before Mesothelioma Surgery
Doctors at the Princess Margaret Cancer Center in Toronto ran a clinical trial called SMART. SMART stands for Surgery for Mesothelioma After Radiation Therapy.
In this trial, they used hypofractionated radiation for mesothelioma patients who were going to have a lung removed. Doctors call the lung-removing procedure EPP.
Because hypofractionated radiation is faster than standard radiation, mesothelioma patients can have surgery before bad side effects developed.
Sixty-six percent of mesothelioma patients in the SMART trial lived for three years. The median survival was 51 months. This is much better than the average mesothelioma life expectancy of 18 months.
Radiation with EPP Versus PD
But EPP has drawbacks including serious side effects. These days, many mesothelioma surgeons prefer to leave both lungs in place. Instead of EPP, they use a less radical approach called PD.
The Toronto team will soon test hypofractionated radiation in patients having PD surgery instead of EPP. This trial will go by the acronym SMARTER.
Radiation and Mesothelioma Immunotherapy Treatment
Dr. Marc de Perrot of Toronto General Hospital was a lead researcher on the SMART trial. He recently published an editorial in the Journal of Thoracic Disease.
In it, he talks about the SMARTER trial. He also suggests that radiation might help mesothelioma immunotherapy treatment work better. It could even become the main way to treat the asbestos cancer.
“The combination of non-ablative hypofractionated radiation with targeted immunotherapy is a promising strategy for the near future in mesothelioma,” writes Dr. de Perrot.
There are already clinical trials testing hypofractionated radiation with immunotherapy drugs. Dr. de Perrot says more study could improve mesothelioma immunotherapy treatment.
“Better understanding of its impact on the immune system will open the door for new exciting therapy in mesothelioma with immune therapy,” he concludes.
de Perrot, M and Cho, J, “Non-ablative hypofractionated hemithoracic radiation—a new standard of care in mesothelioma?”, November 2018, Journal of Thoracic Disease, http://jtd.amegroups.com/article/view/24538/html