Questions Arise Concerning the Use of Radiotherapy after Chemo and Surgery for Mesothelioma

A recent study will likely change the approach in some mesothelioma cancer cases, based on the results published in the journal The Lancet Oncology. The study shows the routine use of hemithoracic radiotherapy after neoadjuvant chemotherapy and extrapleural pneumonectomy is not advisable for patients with malignant pleural mesothelioma.

According to current protocol, post-operative hemithoracic radiotherapy is used for treating malignant mesothelioma, but until now had not been evaluated in a randomized trial, although there are many publications describing its use as an integral part of therapy, including seven phase II studies.

The recent international phase 2 trial included 151 mesothelioma patients. Of them, 113 underwent extrapleural pneumonectomy. About one-third were then assigned to complete macroscopic resection and to receive either high-dose radiotherapy or no radiotherapy treatment. The survival rate of the no radiotherapy group was an average of 7.6 months, while the radiotherapy group averaged 9.4 months. One subject died as a result of radiotherapy-associated pneumonitis.

Some speculate radiotherapy could play a role in the palliative care of pain in patients with end-stage disease who have developed a resistance to opiates, steroids, anticonvulsants, anesthetic agents, and nonsteroidal anti-inflammatory agents. Further studies that show improved pain control and tolerable side effects are required. 

What is Radiotherapy?

Radiotherapy, also known as radiation therapy, treats cancer by using high energy waves to kill tumor cells, the goal being to destroy or damage unhealthy cells without damaging healthy ones. Side effects are common, but vary based on the patient and his or her overall health, the location of the cancer and where treatment is targeted, and now much radiation is given.

Side effects are also short- and long-term. Most people experience fatigue and skin problems during and shortly after they receive treatment. In most cases, these side effects clear up once treatment is complete. Long-term side effects can be permanent and vary based on where treatment was targeted.

For instance, someone who receives radiotherapy near the abdomen could develop long-term bowel issues. Radiotherapy can also trigger cancer to develop in the future, so it is important to speak with your doctor about your specific benefits and risks, in addition to the medical data.

Mesothelioma

Mesothelioma cancer occurs in the mesothelium, the protective membrane lining most of the body’s internal organs. Three out of every four cases begin in the chest cavity, but it is also common for it to occur in the abdomen or heart. For many, by the time mesothelioma is diagnosed, the disease has advanced and affected other parts of the body, and the prognosis rate is rarely good, with a five year survival rate of 10% or less. It is a relatively rare form of cancer and only about 3000 new cases in the United States are diagnosed each year.

The majority of people who develop mesothelioma worked with asbestos at some point in their lives (about 75% of cases). On the job, the risk for inhaling or swallowing asbestos fibers is much higher than normal and long-term exposure increases the risk cancer will eventually develop. There is also a suspected increased risk for those who live with people who work around asbestos.

Radiotherapy has long been thought an effective part of treatment for mesothelioma patients, especially when used in conjunction with first-line defense treatments like surgery and chemotherapy, but the recent information in The Lancet Oncology shows this may not be the case.

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