Clapper, Patti, Schweizer and Mason

As with any form of treatment, the more familiar a doctor or surgeon is, the better the results will be.  This was confirmed recently by a retrospective study at Duke University’s Medical Center.  Researchers examined several cases of mesothelioma that were treated with Intensity Modulated Radiation Therapy (IMRT) and discovered that those patients treated in the past when the procedure was still relatively new experienced less favorable prognoses.  However, patients treated after practitioners had gained significant experience with the procedure experienced much better results.

The data was pulled from medical records of patients who underwent IMRT between 2005 and 2010.  All 30 of the patients had undergone extrapleural pneumonectomy (EPP) for mesothelioma, an extremely radical surgical procedure which involves removal of the entire lung in addition to portions of the diaphragm and the membranes surrounding the lungs and possibly the heart. 

IMRT was developed to help eliminate the negative effects of general radiation therapy.  Because of the nature of the treatment, radiologists are able to more accurately target the affected tissue and keep the radiation from straying to healthy tissue.  However, in order to achieve optimal results, the amount of precision required is monumental. 

The study examined the individual patient’s response to the radiotherapy in addition to the contamination of the remaining lung and surrounding tissues. 

The study participants were tracked for two years and over that time 47% of the 30 achieved local control of their cancer.  Thirty-four were fortunate enough to experience cancer-free survival for that same two year period.  Though that success did not come without a cost.  The overall survival rates of the patient group was calculated at just 50%.

Noticing a peculiar trend in the data, researchers correlated date of treatment with the relative “success” of the treatment.  They discovered that those patients who were treated back in 2005 fared worse.  Those who were treated closer to 2010 fared much better.  The only rationalization they could come up with was that 1) the nuances of IMRT were better understood over time, and 2) the therapists who performed the procedures were more experienced with the technicalities of the treatment. 

In addition, the amount of “stray” radiation decreased over time as well.  Specifically, high levels of toxicity were measured in the remaining lung of 4 out of the first 15 patients.  However, no toxicity was discovered in the remaining lung of the last 15 patients to undergo this procedure. 

However, the success in this study is very relative.  The overall median survival rate of all the patients was just 23.2 months.  This combined with the results of several other studies have led researchers and scientists alike to call into question the validity of treatments for pleural mesothelioma that include extrapleural pneumonectomies and radiation therapy.  Many oncologists are now leaning toward less invasive procedures such as pleurectomies combined with various forms of chemotherapy instead. 

Still, the basic axiom uncovered by the Duke research that the more experienced a doctor is, the better their patients will be, holds true for those treatments as well.  That’s why it’s important that mesothelioma patients take control over their own treatment regimens and understand all of their options.  While the doctor’s input is very important, the agreed upon treatments should always fall in line with the patient’s expectations, goals, and level of comfort. 

Source:

Patel, PR, et al, “Effect of increasing experience on dosimetric and clinical outcomes in the management of malignant pleural mesothelioma with intensity modulated radiation therapy”, May 2012, International Journal of Oncology, Biology and Physics, pp. 362-368.

Source:

http://www.survivingmesothelioma.com/news/view.asp?ID=001283