Therapy Before Mesothelioma Surgery: Which is Better?

Targeted radiotherapy may be just as safe a way to prepare people for radical mesothelioma surgery as chemotherapy and may even result in less need for blood transfusion.

That is the conclusion of a team of Canadian researchers who ran the first ever comparison of induction chemotherapy and induction radiotherapy in mesothelioma surgical outcomes.

Induction Therapy for Mesothelioma

In the context of mesothelioma treatment, induction therapy simply means the first in a series of therapeutic interventions.

For mesothelioma patients, induction chemotherapy or targeted radiotherapy such as intensity modulated radiotherapy (IMRT) can help improve surgical outcomes by shrinking the size of the tumor, increasing the odds that the surgeon can remove all of it.

Induction therapy is also thought to help keep residual mesothelioma cells from growing into new tumors after surgery. But like all therapies, induction therapies carry their own set of risks and side effects.

Chemotherapy vs Radiotherapy Prior to Mesothelioma Surgery

To test the post-surgical impact of these two types of induction therapy, doctors in the areas of pain management, radiation, oncology and thoracic surgery at Princess Margaret Cancer Centre in Toronto conducted a retrospective study on every mesothelioma patient who underwent extrapleural pneumonectomy (EPP) surgery from 2001 to December 2014.

After excluding patients who did not have any induction therapy or who had both types, the team divided the remaining 126 mesothelioma surgery patients into two groups – those who had chemotherapy (64) and those who had IMRT (62).

Reducing Mesothelioma Surgical Risk

When they analyzed the outcome data on all of the EPP surgeries, the research team concluded that, not only did IMRT not increase the surgical risk for mesothelioma patients, but it might also offer some advantages over chemotherapy, especially for the most fragile patients.

“Induction IMRT was significantly associated with a decreased risk of transfusion with red blood cells as well as plasma and platelets,” writes thoracic surgeon Pierre Mordant, MD.

In addition, even though the mesothelioma patients who had IMRT rather than chemotherapy prior to surgery tended to be older with more advanced tumors, the number of complications and the 90-day mortality rates for the two groups were comparable.

“IMRT was not associated with any significant increase in the surgical risks above and beyond induction chemotherapy,” states the report.

If you are considering induction therapy prior to mesothelioma surgery, your doctor can help you decide which type will be safest and most effective.

Source:

Mordant, P, “Impact of induction therapy on postoperative outcome after extrapleural pneumonectomy for malignant pleural mesothelioma: does induction-accelerated hemithoracic radiation increase the surgical risk?”, March 22, 2016, European Journal of Cardiothoracic Surgery, Epub ahead of print