Clapper, Patti, Schweizer and Mason

Experts are currently debating whether or not radiation therapy, administered either before or after surgery,  holds any real benefits for mesothelioma patients.  Various studies seem to support both sides of the argument with some finding little to no beneficial attributes while others report distinct improvements.  A recent study by Malcolm Feigen of the Austin Health Radiation Oncology Center in Melbourne, Australia apparently demonstrates that a certain type of radiotherapy does indeed have benefits for certain types of mesothelioma patients. 

The study examined the effect of high-dose hemithoracic radiation (radiotherapy delivered to one side of the chest cavity) as a mesothelioma treatment for patients diagnosed with malignant pleural mesothelioma (MPM).  Doctor Feigen’s findings point to extended life spans and better survival rates as evidence that radiotherapy should not yet be discounted.  However, the sample size for this individual study is quite small, just 45 individual patients, therefore the results may be skewed.

Feigen presented his findings at the annual European Lung Cancer Conference, opening by saying “I stood before [the ELCC] 2 years ago . . . and asked whether there was a role for high-dose hemithoracic radiotherapy in unpneumonectomized mesothelioma patients."  Feigen went on to state the answer to that question is “absolutely” and called radiation “. . . arguably the most effective single agent for mesothelioma.”

Feigen worked mostly with patients who underwent intensity-modulate radiotherapy (IMRT) which is believed to be a much more effective and safe method of delivering radiation on target.  This narrow application of high-dose radiation allows doctors to spare surrounding tissues from unintentional damage and minimizes the risk associated with radiotherapy. 

However, some experts have called into question Feigen’s reliance solely on radiotherapy.  Many studies have found that multi-modal treatments for mesothelioma, including cytoreductive surgery and chemotherapy, have very beneficial effects.  Indeed, Dr. Paul Baas reminded the audience that such radiation may interfere with chemotherapy.  However, Feigen remained adamant about the validity of his study.

The study participants were broken into two groups:

1. Those who underwent by 3-D conformal radiation therapy
2. And those who underwent IMRT.

The median overall survival rate for the patients in group one was just 7.9 months.  However, those in group two enjoyed a median overall survival rate of 12.4 months. 

Combine that figure with 1-year survival rates of 44% and 54%, respectively, and you can begin to see why Feigen was so excited about his findings.  However, similar rates have been observed in patients undergoing some forms of combine multimodal therapies – so why all the fuss?

Not all patients are candidates for multimodal mesothelioma treatments.  Indeed, every individual mesothelioma patient is different and the circumstances of their illness and the modalities of their treatment are, by necessity, very personalized.  Some patients, due to age, frailties, or personal preference, are excluded from radical surgery and/or chemotherapy.  While many multimodal approaches also adopt some form of radiotherapy, Feigen’s findings demonstrate that radiation alone may be able to help those patients who cannot or choose not to opt for more aggressive treatments.

While Baas agreed that Feigen’s treatments had merit, he called for a joint study “because if everybody goes on doing what he or she thinks is best at his or her hospital, then we will not be able to compare the results."

Source:  Promising Developments in Early Diagnosis and Treatment of Mesothelioma