Radiation therapy in the management of patients with mesothelioma

Our plain-English summary of Radiation therapy in the management of patients with mesothelioma, by W. Gordon, K.H. Antman, J.S. Greenberger, et al (International Journal of Radiation Oncology, Biology, Physics, 1982).

The study

• Authors: W. Gordon, K.H. Antman, J.S. Greenberger, R.R. Weichselbaum, J.T. Chaffey
• Journal: International Journal of Radiation Oncology, Biology, Physics
• Published: 1982;8(1):19-25
• Cited by: 103 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The results of radiation therapy in the management of 27 patients with malignant mesothelioma were reviewed. Eight patients were treated with a curative intent combining attempted surgical excision of tumor (thoracic in 6 and peritoneal in 2), aggressive radiation therapy, and combination chemotherapy using an adriamycin-containing regimen. One patient achieved a 2-year disease-free interval followed by recurrence of tumor above the thoracic irradiation field. This patient was retreated with localized irradiation and is disease-free after 5 years of initial diagnosis. One patient has persistent abdominal disease at 18 months; the other 6 patients suffered local recurrence within 8-13 months of initiation of treatment. Radiation therapy was used in 19 other patients who received 29 courses for palliation of dyspnea, superior vena cava syndrome, dysphagia, or neurological symptoms of brain metastasis. A palliation index was used to determine the effectiveness of irradiation and revealed that relief of symptoms was complete or substantial in 5 treatment courses, moderately effective in 6 courses and inadequate in 18 treatment courses. Adequate palliation strongly correlated with a dose at or above 4,000 rad in 4 weeks. The management of patients with mesothelioma requires new and innovative approaches to increase the effectiveness of radiation therapy and minimize the significant potential combined toxicity of pulmonary irradiation and adriamycin.

In plain English

The authors reviewed records of malignant mesothelioma patients given radiation therapy at a Boston center from 1968 to 1980. Of 33 patients with confirmed malignant mesothelioma, 27 received radiation. Eight were treated with intent to cure, using attempted surgical removal and radiation; some also received chemotherapy. Six had disease in the pleural cavity or mediastinum and two peritoneal or abdominal disease. One of the eight had a recurrence above the irradiated chest area at 24 months, was retreated, and was alive without disease 5 years after initial therapy. One was alive with persistent local disease at 18 months. One died at 6 months after a cerebral embolus. Five had local disease at death, 8 to 13 months after treatment began. Nineteen other patients received 29 radiation courses to relieve symptoms, and 18 of the 29 courses gave insignificant relief. Four of six courses of 4000 rad or more gave significant relief, compared with one of 16 courses of 2000-3600 rad. The authors concluded whole-lung irradiation was not effective against gross mesothelioma and cautioned that adriamycin may add significant risk.

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: Retrospective review of treatment records (case series) at a single radiation therapy center
• Who was studied: 37 patients were evaluated at the Joint Center for Radiation Therapy (Harvard Medical School, Boston), 1968 to 1980. Of these, 33 had pathologist-confirmed malignant mesothelioma and 27 received radiation therapy. Eight were treated with curative intent: ages 26 to 60, 3 female and 5 male, 6 with pleural cavity or mediastinal disease and 2 with peritoneal or abdominal disease. Nineteen were treated for palliation: 18 male and 1 female, 2 with peritoneal mesothelioma and the rest with pleural primaries.
• Exposure: The study examined radiation therapy, not asbestos exposure. Treatment was external beam radiation from a 4 MeV or 8 MeV linear accelerator, at total doses of 800 to 5700 rad. In the curative group, all eight had attempted surgical resection plus radiation, and some, not all, also received chemotherapy, including adriamycin-containing regimens. Asbestos exposure by history is marked only in a footnote to Table 1. The scanned table is too garbled to count reliably which patients were marked.
• Main results:
  • Curative-intent group (8 patients): in all 8, some tumor was left behind after surgery.
  • Curative-intent group: not all eight received chemotherapy. The article states that four received an adriamycin-containing regimen after radiation, but it then names five chemotherapy recipients (patients 1, 2, 3, 6 and 7).
  • Curative-intent group: one patient (patient 8) had a local recurrence in the right chest above the irradiated area 24 months after therapy. This patient received a second course of 5000 rad and was alive without disease 5 years after initial therapy.
  • Curative-intent group: patient 3 was alive with active local persistent disease at 18 months.
  • Curative-intent group: patient 7 had pneumonia and sepsis during treatment, then a cerebral embolus, and died 6 months after treatment began. Persistent local disease was found at postmortem.
  • Curative-intent group: the other five patients had active local disease at death, between 8 and 13 months after treatment began. One of the five also had distant metastases.
  • Curative-intent group: because of the combined toxicity of radiation and chemotherapy, not all patients could receive full chemotherapy courses.
  • Palliative group (19 patients, 29 courses): one patient (patient 2) got complete relief of symptoms. Four other courses gave significant relief of pain or shortness of breath within 12 weeks.
  • Palliative group: six patients had moderate relief within 12 weeks, and 18 of the 29 courses gave insignificant relief.
  • Palliative group, by dose: four of six courses delivering 4000 rad or more gave significant symptom relief, compared with one of 16 courses of 2000-3600 rad. The results section gives this as 4000-5000 rad in 6 courses, with significant relief in 4 instances (66%).
• The authors' conclusion: The authors concluded that whole-lung external beam irradiation was not effective for controlling gross malignant mesothelioma. They also concluded that conventional doses given safely did not control 1-2 mm nodules spread over the visceral pleura, and that new radiation techniques are needed. They cautioned that giving adriamycin chemotherapy at the same time may pose significant additional risk.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Chemotherapy, Dyspnea, Superior Vena Cava Syndrome, Dysphagia, Metastasis.

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• Multimodality therapy for malignant mesothelioma based on a study of natural history — K.H. Antman, R.H. Blum, et al. (1980)
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