High-Dose Radiation, Pleurectomy Shows Promise in Controlling Mesothelioma

Patient receiving external beam radiation in a linear accelerato

High dose radiation therapy, as a follow-up to aggressive pleurectomy/decortication surgery for patients with pleural mesothelioma, has produced impressive results in a recent Italian study.

Researchers in the Department of Radiation Oncology at the Centro di Riferimento Oncologico di Aviano, in northern Italy, reported a median survival rate of 33 months for the 20 consecutive patients enrolled at the cancer
institute.

“We think our approach is a concrete alternative option for the cure of MPM (malignant pleural mesothelioma),” lead researcher Emilio Minatel, M.D., told Asbestos.com. “We have very encouraging results of local control and survival in a very select population.”

The results were published in the November edition of the international journal Lung Cancer. The study provided some much-needed encouragement for mesothelioma patients. There currently is no cure for mesothelioma cancer, which is caused by exposure to asbestos fibers.

The results also have delivered fuel to the on-going debate about those who believe that lung-sparing P/D surgery is a better option than the more-radical extrapleural pneumonectomy (EPP), which involves the removal of an entire lung.

The survival rate in the study was 70 percent at two years and 49 percent at three years or more. The estimated progression-free survival rate was 68 percent at two years and 46 percent at three years.

The radiation dosage used in the study was 50Gy in 25 fractions. Areas of particular concern for residual disease were boosted to 60Gy. Of the 20 patients, 19 also received a cisplatin/pemetrexed chemotherapy regimen.

“We have shown that it is feasible to deliver full dose radiation following lung-sparing surgery,” Minatel said. “We also think that high dose radiation might have a prognostic role in patients who did not undergo radical surgery.”

Second Study from Italy Questions Aggressive Surgery

Although the results were among the best ever observed in mesothelioma patients, another multicenter study in Italy has raised the question of whether any type of aggressive surgery really offers any survival advantage for mesothelioma patients.

The second study was part of an Oral Abstract Presentation at the World Conference on Lung Cancer in Australia last month, made by Andrea Bille, M.D., of Istituto Nazionale dei Tumori, in Milan, Italy.

That study involved 1,365 patients with mesothelioma. They were treated between 1982 and 2012, and divided into three categories. Those who underwent the P/D surgery had an average survival of 20.5 months. Patients who underwent the EPP surgery survived an average of 18.8 months. Test subject who had only chemotherapy or palliative care lasted just 11.7 months.

The belief is that only the healthiest patients even qualify for surgery, making them more likely to survive longer regardless of the treatment approach.

When the same three groups were compared by using only those with “favorable prognostic factors,” which meant younger, healthier patients, there was little or no difference in the survival times. The difference ranged from 1 to 3 months, whether the patients had surgery or not.

The surgeries also came with lengthy recovery periods, which immediately raised quality of life issues.

“The modest benefit observed after surgery over medical treatment requires further investigation,” the authors reported at the Lung Cancer Conference. “Our data suggests that patients with good prognostic factors had similar survival whether they received medical therapy only, P/D or EPP.”

  1. Minatel, E., M.D., Department of Radiation Oncology, Centro di Riferimento Oncologico of Avian, Italy, interview with Asbestos.com (2013, Nov. 26).
  2. Bille, A., Does Surgery Improve Survival of patients with malignant pleural mesothelioma? 15th World Conference on Lung Cancer. (2013, Oct. 28). Retrieved from: http://abstracts.webges.com/wclc2013/myitinerary
  3. http://www.lungcancerjournal.info/article/S0169-5002%2813%2900457-1/fulltext
  4. http://www.lungcancerjournal.info/article/S0169-5002%2813%2900457-1/abstract

Tim Povtak is an award-winning writer with more than 30 years of reporting national and international news. His most recent experience is in researching and writing about asbestos litigation issues and asbestos-related conditions like mesothelioma. If you have a story idea for Tim, please email him at tpovtak@asbestos.com

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