Malignant pleural mesothelioma: when is radiation therapy indicated?

Our plain-English summary of Malignant pleural mesothelioma: when is radiation therapy indicated?, by E.R. van Thiel, V.F. Surmont, J.P. van Meerbeeck (Expert Review of Anticancer Therapy, 2011).

The study

• Authors: E.R. van Thiel, V.F. Surmont, J.P. van Meerbeeck
• Journal: Expert Review of Anticancer Therapy
• Published: 2011;11(4):551-60
• Type of article: Review
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma is an aggressive tumor of serosal surfaces resistant to many current treatment options. This article will provide a comprehensive discussion of the latest developments in the treatment of malignant pleural mesothelioma, with a focus on radiation therapy. We will discuss the role of radiotherapy as a prophylactic, palliative and potentially curative treatment of malignant pleural mesothelioma. An update will be provided of the latest clinical trials including new treatment.

In plain English

This article was a review of radiation therapy for malignant pleural mesothelioma, a cancer of the lining around the lungs. It did not study asbestos exposure. The authors searched MEDLINE for English-language papers on radiotherapy used for symptom relief, for preventing tumor spread along biopsy and drain tracts, as a stand-alone curative treatment, and after surgery. Among the studies they described, one prospective study reported pain control in 13 of 19 patients (68%), but the effect was short-lived. A meta-analysis of three trials of preventive radiotherapy to procedure sites found a non-significant reduction in tract metastases (relative risk 0.47; 95% CI 0.01–30.90). In one radical radiotherapy series, 2 of 12 patients (17%) developed fatal complications. In another study, 6 of 13 patients given IMRT after extrapleural pneumonectomy developed fatal radiation pneumonitis. In a European trial combining chemotherapy, surgery and radiotherapy, 37 patients (65%) completed radiotherapy and median survival was 18.4 months. The authors concluded that the best-evidenced use was palliative radiotherapy for pain, and they noted that few randomized trials existed.

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: Narrative review (published as a 'Perspective') of radiotherapy for malignant pleural mesothelioma, based on a MEDLINE/PubMed search
• Who was studied: Published English-language studies, found through MEDLINE, on radiotherapy for patients with malignant pleural mesothelioma
• Exposure: Not an asbestos exposure study. The subject was radiation therapy (palliative, prophylactic, radical, and postoperative or multimodality). The background section names asbestos, especially crocidolite, as the main cause of mesothelioma.
• Main results:
  • Palliative radiotherapy: in a prospective study by Bissett et al. cited by the review, 30 Gy in ten fractions to the hemithorax gave adequate pain control in 13 of 19 patients (68%). The response was short-lived: at 5 months, six of seven patients had lost pain control.
  • Prophylactic radiotherapy of procedure tracts: a cited meta-analysis pooling three randomized trials found a non-significant reduction in the relative risk of tract metastasis (relative risk 0.47; 95% CI 0.01–30.90).
  • Radical radiotherapy: in a cited series by Ball and Cruickshank, 2 of 12 patients (17%) given radical radiotherapy developed fatal complications. Older retrospective studies showed no survival benefit compared with best-supportive care.
  • IMRT after extrapleural pneumonectomy: in Miles et al., 6 of 13 patients developed fatal radiation pneumonitis. Rice et al. reported 6 of 63 patients with fatal pulmonary toxicities within 6 months.
  • Trimodality treatment: in the cited EORTC Phase II trial (neoadjuvant cisplatin and pemetrexed, extrapleural pneumonectomy, then postoperative radiotherapy), 37 patients (65%) completed radiotherapy and median overall survival was 18.4 months.
• The authors' conclusion: The authors concluded that the best-evidenced indication is palliative radiotherapy for pain. Prophylactic tract irradiation remains questionable. Postoperative radiotherapy should be considered only within multimodality treatment in very selected patients. IMRT should be used cautiously and in expert centers only.
• Limitations the authors state:
  • Few randomized controlled trials had evaluated radiotherapy's efficacy, scheme or dosage.
  • Many of the palliative radiotherapy series reviewed were small, retrospective and prone to bias.
  • The review considered only English-language papers.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Serosal Surface, Palliative Care, Clinical Trial.

Related studies

• A Novel Prospective Study Assessing the Combination of Photodynamic Therapy and Proton Radiation Therapy: Safety and Outcomes When Treating Malignant Pleural Mesothelioma — S.R. Rice, Y.R. Li, et al. (2019)
• A feasibility study evaluating Surgery for Mesothelioma After Radiation Therapy: the "SMART" approach for resectable malignant pleural mesothelioma — B.C. Cho, R. Feld, et al. (2014)
• Patterns of failure, toxicity, and survival after extrapleural pneumonectomy and hemithoracic intensity-modulated radiation therapy for malignant pleural mesothelioma — D.R. Gomez, D.S. Hong, et al. (2013)
• Hemithoracic radiation therapy after extrapleural pneumonectomy for malignant pleural mesothelioma: Applicable to all and by all? — R. Haas, P. Baas (2015)
• Radiation therapy in the management of patients with mesothelioma — W. Gordon, K.H. Antman, et al. (1982)
• Unusual radiologic findings in the thorax after radiation therapy — B. Mesurolle, S.D. Qanadli, et al. (2000)

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