Hemithoracic radiotherapy for mesothelioma: lack of benefit or lack of statistical power? - Authors' reply

Our plain-English summary of Hemithoracic radiotherapy for mesothelioma: lack of benefit or lack of statistical power? - Authors' reply, by O. Riesterer, W. Weder, R. Stahel (The Lancet. Oncology, 2016).

The study

• Authors: O. Riesterer, W. Weder, R. Stahel
• Journal: The Lancet. Oncology
• Published: 2016;17(2):e44-e45
• Type of article: Letter, Comment
• Read it: PubMed · Publisher

In plain English

This item is not a research study but a letter: the authors' reply to correspondence about their own trial, SAKK 17/04. That trial tested hemithoracic radiotherapy after chemotherapy and extrapleural pneumonectomy in malignant pleural mesothelioma. Andreas Rimner and colleagues had argued that the trial's conclusions were not supported by its data. The authors disagreed. They wrote that, despite some methodological limitations, the trial failed to show a meaningful benefit, so its conclusion that the findings do not support routine use of hemithoracic radiotherapy was fully supported. They noted that SAKK 17/04 was the only randomised study of radiotherapy after extrapleural pneumonectomy, and that in single-arm studies overall survival remained dismal. They described the trial's toxicity, which included one case of fatal pneumonitis, as acceptable and compatible with the literature, and said this toxicity led to tighter lung dose limits. They also said a review of the trial's radiotherapy was planned. In their opinion, locally confined radiotherapy could be considered in individual treatment decisions, but not for routine use. The letter does not report a new study and does not discuss asbestos.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Letter (authors' reply to correspondence about their published randomised phase 2 trial, SAKK 17/04); it does not report a new study
• Who was studied: Patients with malignant pleural mesothelioma treated in the SAKK 17/04 trial; the letter gives no patient numbers
• Exposure: No asbestos exposure is discussed; the treatment at issue is hemithoracic radiotherapy given after extrapleural pneumonectomy (trimodality treatment)
• Main results:
  • The authors stated that SAKK 17/04 is the only randomised study of postoperative radiotherapy after extrapleural pneumonectomy; other studies have been single-arm phase 2 feasibility studies
  • Citing earlier single-arm studies, the authors wrote that although many patients achieved locoregional control after extrapleural pneumonectomy and intensity-modulated radiotherapy, overall survival remained dismal
  • About half the trial's patients received intensity-modulated radiotherapy, and the radiation schedules were slightly different but, according to the authors, biologically equivalent
  • The authors described the trial's overall toxicity, which included one case of fatal pneumonitis, as acceptable and compatible with the literature. They said this toxicity led to tighter lung limits: mean lung dose less than 7 Gy, volume of lung receiving at least 20 Gy less than 5%, and volume receiving at least 5 Gy less than 40%
  • A comprehensive review of the trial's radiotherapy was planned, to look at the influence of different radiation techniques and to relate recurrence patterns to radiation fields and dose levels
• The authors' conclusion: The authors held that their trial's conclusion against routine use of hemithoracic radiotherapy is supported by the data. In their opinion, locally confined radiotherapy could be considered in individual treatment decisions but not for routine use
• Limitations the authors state:
  • The authors acknowledged that their trial had some methodological limitations, without specifying them in the reply

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma.

Related studies

• Hemithoracic radiotherapy for mesothelioma: lack of benefit or lack of statistical power? — A. Rimner, C.B. Simone, et al. (2016)
• Multimodal treatment for malignant pleural mesothelioma — R.C. Rintoul, T. Treasure, et al. (2015)
• Importance of excision repair cross-complementation group 1 and ribonucleotide reductase M1 as prognostic biomarkers in malignant pleural mesothelioma treated with platinum-based induction chemotherapy followed by surgery — L. Frischknecht, M. Meerang, et al. (2015)
• Updated patterns of failure after multimodality therapy for malignant pleural mesothelioma — E.H. Baldini, W.G. Richards, et al. (2015)
• Accelerated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma — M. de Perrot, R. Feld, et al. (2016)
• Trimodality strategy for treating malignant pleural mesothelioma: results of a feasibility study of induction pemetrexed plus cisplatin followed by extrapleural pneumonectomy and postoperative hemithoracic radiation (Japan Mesothelioma Interest Group 0601 Trial) — S. Hasegawa, M. Okada, et al. (2016)

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