Study: Experienced Hands Work Best with IMRT for Mesothelioma Patients

This should come as no surprise, but experience can be invaluable.

For someone with mesothelioma, it could mean extending life.

Just because a facility has the latest radiotherapy technology doesn’t mean they can make the best use of it. There is the human element that makes it work at the optimal level.

According to one study done by the radiation oncology researchers at the Duke University Medical Center, patients who were treated by radiologists with more experience had better success rates.

The details of the study were published in the International Journal of Radiation Oncology, Biology and Physics.

Researchers reviewed the records of 30 mesothelioma patients who underwent Intensity Modulated Radiation Therapy (IMRT) following an extrapleural pneumonectomy, a radical surgical procedure that removes a lung, the lining around it, and at least part of the diaphragm.

IMRT is designed to direct radiation specifically to kill remaining tumors and reduce the risk of damage to the healthy tissues that surround them.

The study also found that the more experience the radiologists had, the less damage was done to the healthy tissue and nearby organs with the radiation.

“Increasing experience planning malignant pleural mesothelioma cases was associated with improved coverage of planning target volumes,” reported the researchers.

The value of experience should not have been too surprising, particularly with mesothelioma, a rare cancer that hits only 2,000-3,000 patients annually in the United States. The rarity is what makes it so imperative in finding experienced doctors to treat it. There are few.

Mesothelioma, which is almost always caused by an exposure to asbestos, often goes misdiagnosed until late stages because the early symptoms often mirror those of less serious illnesses.

The study was based on patients who had the IMRT from 2005 to 2010. The median survival was 23.2 months.

The two-year local control of the cancer was 47 percent and the two-year disease-free survival was 34 percent.

In the first 15 patients that were studied, four developed lung toxicity from the radiation, but none of the final 15 did when the radiologists were more experienced with the IMRT.

The study comes on the heels of findings from Australia which found certain high-dose hemithoracic radiation treatments were increasing survival rates significantly.

While the Duke study concluded that experience was vital to success, it also made clear that there were no guarantees with radiation therapy, which still has its flaws in fighting mesothelioma.

“With increasing experience, target volume coverage improved and dose to the contralateral lung decreased,” said the authors in the conclusion. “Rates of pulmonary toxicity were relatively low. However, both local and distant control rates remained suboptimal.”

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