Radiotherapy for the treatment of pain in malignant pleural mesothelioma: a systematic review

Our plain-English summary of Radiotherapy for the treatment of pain in malignant pleural mesothelioma: a systematic review, by N. Macleod, A. Price, N. O'Rourke, et al (Lung Cancer, 2014).

The study

• Authors: N. Macleod, A. Price, N. O'Rourke, M. Fallon, B. Laird
• Journal: Lung Cancer
• Published: 2014;83(2):133-8
• Type of article: Systematic review
• Cited by: 28 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Radiotherapy is commonly used to treat pain in malignant pleural mesothelioma (MPM). The purpose of this systematic review is to examine the evidence for this practice. Medline (1946-2013), Embase (1974-2013) and Central (The Cochrane Library Issue 9, 2012) databases were searched. Eligible studies met the following criteria: MPM (histological or radiological diagnosis), radiotherapy given with the intent of improving pain, response rates to radiotherapy reported, dose and fractionation reported and the relationship between radiotherapy and pain response explored. All studies had independent review and were graded according to evidence level. Eight studies met the eligibility criteria. Two studies were prospective single arm phase II studies while the remainder were retrospective case series. All were graded as either Level 2 or Level 3 evidence. Due to marked heterogeneity among studies, quantitative synthesis of results was not possible. No high quality evidence currently exists to support radiotherapy in treating pain in MPM. Studies focusing on clear pain endpoints and improving target delineation are needed. Such studies should also use modern radiotherapy techniques and concentrate on dose escalation.

Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

In plain English

This was a systematic review. The authors searched the Medline, Embase and Cochrane CENTRAL databases for studies of radiotherapy given to relieve pain in malignant pleural mesothelioma (MPM). Eight studies met their criteria. Two were prospective single-arm phase II studies and six were retrospective case series. Each came from a single institution and included 19 to 189 patients. Doses ranged from 8 Gy in 1 or 2 fractions to 60 Gy in 30 fractions. Only two studies measured pain scores prospectively. Reported benefit ranged from no benefit to a 69% response. One prospective study, which the authors judged the strongest evidence, reported a 68% response. In the other prospective study, 27 of 47 patients had no pain at entry, and no benefit in pain scores was seen. The studies gave little data on toxicity. All were graded Level 2 or 3 evidence, and differences among them prevented combining their results. The authors concluded that no high quality evidence currently exists to support radiotherapy for pain in MPM.

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: Systematic review of published studies, searching the Medline (1946–2013), Embase (1974–2013) and Cochrane CENTRAL databases
• Who was studied: Eight studies of patients with malignant pleural mesothelioma, each from a single institution, with 19 to 189 patients per study
• Exposure: Radiotherapy given to relieve pain, at doses from 8 Gy in 1 or 2 fractions to 60 Gy in 30 fractions (not an asbestos exposure)
• Main results:
  • Of the eight included studies, two were prospective single-arm phase II studies and the other six were retrospective case series
  • Pain scores were assessed prospectively in only two of the studies
  • Across the included studies, reported benefit ranged from no benefit to a 69% response
  • The Bissett et al. prospective study, which the authors judged the strongest evidence, reported a 68% response rate
  • In the other prospective study (Linden), 27 of the 47 patients had no pain at study entry
  • The Linden study did not show a benefit in pain scores after irradiation
  • The included studies presented little data on toxicity
  • All included studies were graded as Level 2 or Level 3 evidence
  • Because of marked heterogeneity among the studies, their results could not be combined quantitatively
• The authors' conclusion: The authors concluded that no high quality evidence currently exists to support radiotherapy for treating pain in MPM
• Limitations the authors state:
  • The small number of papers, limited reported information and varying primary endpoints prevented quantitative synthesis
  • The included studies were limited by poor study design and small numbers of patients

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: Pleural Mesothelioma, Systematic Review.

Related studies

• Is Radiotherapy Useful for Treating Pain in Mesothelioma?: A Phase II Trial — N. MacLeod, A. Chalmers, et al. (2015)
• Cordotomy in mesothelioma-related pain: a systematic review — B.D. France, R.A. Lewis, et al. (2014)
• Anterior cingulotomy improves malignant mesothelioma pain and dyspnoea — E.A. Pereira, M. Paranathala, et al. (2014)
• Chronic pleuritic pain in four patients with asbestos induced pleural fibrosis — A. Miller (1990)
• Opioids in pain management of mesothelioma and lung cancer patients — E.K. Salminen, M. Silvoniemi, et al. (2013)
• Pleurectomy for persistent pain in benign asbestos-related pleural disease — D.I. Fielding, J.L. McKeon, et al. (1995)

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