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Radiotherapy and EPP is a Winning Combo for Some Mesothelioma Patients

ByAlex Strauss

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Another study has confirmed the value of radiotherapy as an adjuvant treatment for mesothelioma patients who undergo extrapleural pneumonectomy.

A team of Italian researchers recently analyzed the records of 56 mesothelioma patients who had been treated with adjuvant radiotherapy after extrapleural pneumonectomy surgery (EPP) between 2005 and 2010. Caused by exposure to asbestos, malignant mesothelioma is a fast-growing cancer of the mesothelial lining around the lungs and other organs. Extrapleural pneumonectomy is a radical surgical procedure that involves removing not only the mesothelioma tumors, but also the lung closest to the tumor and a portion of the diaphragm.

Although EPP is controversial due to its high rate of complications, a number of studies have shown it to increase survival, especially in carefully-chosen, otherwise healthy patients with the epithelioid type of mesothelioma. It is still considered the surgical gold standard at a number of top mesothelioma centers.

Four of the EPP-treated mesothelioma patients in the retrospective Italian study were treated with Intensity Modulated Radiotherapy (IMRT,) and two with helical tomotherapy. The patients were all treated with 45 to 50Gy to the affected areas inside the chest. Twenty of the patients also got a simultaneous “boost” of 60Gy to the margins around the tumor in an effort to destroy any remaining mesothelioma cells.

Despite the fact that mesothelioma is notoriously hard to control, the results of the Italian study were encouraging. For 90 percent of patients, the mesothelioma was kept under control in the region of the surgery for three years. Sixty-six percent of patients did not experience spread (metastasis) of their mesothelioma during that time. Fifty seven percent of patients were considered disease-free for at least three years.

Sources:

Tonoli, S et al, “Adjuvant radiotherapy after extrapleural pneumonectomy for mesothelioma. Prospective analysis of a multi-institutional series”, November 11, 2011, Radiotherapy and Oncology, Epub ahead of print. Cao, C et al, “Summary of Prognostic Factors and Patient Selection for Extrapleural Pneumonectomy in the Treatment of Malignant Pleural Mesothelioma”, April 22, 2011, Annals of Surgical Oncology.

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