Radiation therapy (RT), and particularly intensity modulated radiation therapy (IMRT), is effective and feasible in the treatment of malignant pleural mesothelioma (MPM), finds a study led by oncologist Kenneth E. Rosenzweig of Mount Sinai’s Icahn School of Medicine in New York.
The study, “Malignant pleural mesothelioma: adjuvant therapy with radiation therapy,” appeared in the journal Annals of Translational Medicine.
To treat MPM, doctors perform surgery such as extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D) to remove the tumor. EPP involves the resection of an entire lung, the surrounding tissues and the diaphragm. P/D involves the removal of just the tumor or the disease, but leaves the lung intact. Therefore, patients who undergo EPP have one lung while patients with P/D have two lungs.
Physicians don’t agree on whether administering RT is actually beneficial for patients with MPM. Since RT can be toxic to patients, it’s crucial to find out whether this treatment offers any advantages.
Studies have shown that survival improves when doctors use multiple therapies to treat MPM rather than just using surgery, but individual studies done before IMRT showed variable results.
One study conducted in a sample of 14,228 mesothelioma patients showed no difference in survival between those who underwent surgery alone and those who had surgery and RT. On the other hand, a different study showed that use of RT improved the two-year survival rate of MPM patients from 20 percent to 34 percent. However, many of these studies were conducted before the advent of IMRT.
In fact, IMRT is among the most important technological advances to RT. A technique that delivers a high dose to specific tumor tissue and a low dose to surrounding normal tissue — causing this technique to be less toxic — IMRT is used on all mesothelioma patients undergoing RT.
However, IMRT requires a lot of expertise. In fact, earlier studies showed that physicians had great difficulty performing IMRT on their patients, especially those lacking experience. Many cancer centers now prefer P/D over EPP because of its decreased surgical toxicity, even though both types of surgeries produce similar clinical outcomes. Since P/D leaves the lung intact, IMRT — which minimizes toxicity to normal tissue — is seen as the best way to deliver RT.
Recent studies have shown that IMRT is a safe procedure now that experience has improved among physicians. It is also associated with great efficacy in many cancer centers, therefore making it both feasible and effective in treatment for MPM post-surgery.
But Rosenzweig notes that it is still significantly toxic, a factor that should be taken into account when devising a treatment strategy for patients.
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