Italian researchers presenting at an international conference this week say the right kind of radiotherapy for mesothelioma can dramatically boost survival.
Radiation oncologist Marco Trovo and his colleagues at the University Hospital of Udine conducted the new mesothelioma research.
They studied 108 pleural mesothelioma patients whose tumors could not be completely removed with surgery. Pleural mesothelioma affects the membrane around the lungs and is usually fatal within a year.
But in the new study, more than half of the patients who had high doses of targeted radiotherapy in just the right area were still alive two years later. In contrast, just over a quarter of the patients who had palliative radiotherapy for mesothelioma lived to two years.
Curative Versus Palliative Radiotherapy for Mesothelioma
Radiotherapy hurts cancer cells by disrupting their DNA, making it harder for them to replicate and spread. Unfortunately, it has the same effect on healthy cells. This problem limits how and where radiotherapy can be used.
Until recently, doctors have mostly used radiotherapy for mesothelioma as a way to help manage mesothelioma symptoms. This is called palliative radiotherapy. If radiation can destroy at least some of the tumor cells, it can potentially slow tumor growth and lessen symptoms.
But the new research suggests that curative radiotherapy for mesothelioma is now possible thanks to new technology.
Instead of just managing symptoms, the goal of this type of radiation is to keep mesothelioma tumors from spreading. The key appears to be targeting just the right area of the chest and giving a high enough dose.
Encouraging Radiotherapy Research
The Italian researchers presented their findings this week at the European Society for Radiotherapy and Oncology (ESTRO) conference in Milan.
They studied mesothelioma patients treated at Italy’s National Cancer Institute between 2014 and 2018. All of the patients had surgery to remove as much of their cancer as possible.
Half of the patients got the typical dose of radiotherapy for mesothelioma. These patients received a total dose of 20-30 Gy to the tumor location in five to ten treatments.
The other half of the pleural mesothelioma patients got a heavier dose of radiation. These patients had 25 treatments to the affected side of their chest for a total dose of 50 Gy. They also got an extra 60 Gy dose to the tumor location.
Fifty-eight percent of the patients who received aggressive radiotherapy for mesothelioma were still living at two years. Only 28 percent of the palliative radiotherapy group were still alive at the same point.
“This research shows a clear survival benefit in using this type of radiotherapy for mesothelioma patients whose tumours can only partially be removed by surgery,” Dr. Trovo says. “We believe that this should be considered the new standard of care for these patients.”
Complications of Radiotherapy for Mesothelioma
The treatment protocol was not without some complications. One in five patients developed a type of lung inflammation called pneumonitis. Other patients reported weakness and/or nausea. Still others had some mild inflammation in the esophagus.
ESTRO’s president, Professor Umberto Ricardi of the University of Turin called it “an extremely positive result”. But he cautioned that radiotherapy for mesothelioma patients should still be delivered in specialty centers with high level expertise and equipment.
“Radiotherapy doubles survival for patients with mesothelioma”, ESTRO new release, April 20, 2019, https://www.estro.org/ESTRO/media/ESTRO/Congresses/ESTRO38/Trovo_mesothelioma_web_1.pdf