Radiotherapy in the treatment of malignant mesothelioma of the pleura, with special reference to its use in palliation

Our plain-English summary of Radiotherapy in the treatment of malignant mesothelioma of the pleura, with special reference to its use in palliation, by S.R. Davis, L. Tan, D.L. Ball (Australasian Radiology, 1994).

The study

• Authors: S.R. Davis, L. Tan, D.L. Ball
• Journal: Australasian Radiology
• Published: 1994;38(3):212-4
• Cited by: 40 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Most patients presenting with malignant mesothelioma of the pleura (MMP) are only suitable for palliative treatment. Radiotherapy has not been shown to improve survival in patients with this disease, but is of use in the palliation of symptoms. In this retrospective review of 111 patients with MMP referred to the Peter MacCallum Cancer Institute, the palliative effect of radiotherapy was analysed. More than half of the patients whose response could be assessed had some symptomatic relief from the radiotherapy treatment. No dose-response relationship could be found.

In plain English

This was a retrospective review of the charts of 111 patients with histologically proven malignant mesothelioma of the pleura referred to the Peter MacCallum Cancer Institute in Melbourne, Australia, from 1980 to 1989. It studied radiotherapy. Of these patients, 87 received at least one course, 145 courses in all, mostly to relieve symptoms, with pain the most common. The estimated median survival of all patients was 5 months from presentation, and an estimated 17% were alive one year later. Where the outcome could be assessed, more than half of courses gave some symptom relief, including 60% of first courses. For first courses, response rates were 66% at 20 Gy or less, 63% at 21 to 39 Gy and 54% at the highest doses (P = 0.5). Three patients died during their first course. Two of the 16 patients given radical radiotherapy (12.5%) developed fatal complications from it after completing treatment. The authors concluded that the palliative effect appeared to be dose-independent. They noted that chart details were often inadequate and that other treatments, such as analgesia and steroids, were hard to account for.

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 chart review (single-institution case series) of radiotherapy for pleural mesothelioma
• Who was studied: 111 patients with histologically proven malignant mesothelioma of the pleura referred to the Peter MacCallum Cancer Institute, Melbourne, Australia, between 1 January 1980 and 31 December 1989. 103 were male and 8 female. Median age at presentation was 63 years (range 34 to 80).
• Exposure: Radiotherapy, not asbestos. 87 patients (78%) received at least one course and 145 courses were prescribed in total (107 megavoltage, 38 orthovoltage). 16 patients received radical radiotherapy and 71 were treated for symptoms. The article does not discuss asbestos exposure or fiber types.
• Main results:
  • In all 111 patients, estimated median survival was 5 months (standard error 0.6 months) from presentation at the institute. An estimated 17% (standard error 4%) were alive at 1 year.
  • Where outcomes were assessed, more than half of courses gave some symptomatic relief. This included 60% of first courses. Rates of relief did not differ significantly between first and later courses.
  • Across all 145 courses, response was none in 45 (31%), some in 37 (26%), good in 27 (19%) and unknown in 33 (23%). For the 87 first courses, the figures were 26 (30%), 27 (31%), 16 (18%) and 15 (17%).
  • In first courses, palliative response rates were 66% for 20 Gy or less, 63% for 21 to 39 Gy and 54% for the 40 Gy category. The highest category's symbol was lost in scanning but appears to mean 40 Gy or more. The chi-squared test for trend gave P = 0.5.
  • Three patients (3%) died while on their first course of treatment. One of them was treated palliatively for pain and two were prescribed radical courses.
  • Two patients who completed radical treatment developed fatal complications due to radiotherapy. They were 12.5% of the 16 patients given radical radiotherapy, not a rate for all patients treated.
• The authors' conclusion: The authors concluded that, in this series, the palliative effect of radiotherapy appeared to be dose-independent. They stated that the institute's policy is to offer short palliative courses to symptomatic sites rather than protracted courses.
• Limitations the authors state:
  • Because the study was retrospective, the information available for each patient varied and follow-up details were often inadequate.
  • Response was judged by one of the authors from details in the patients' charts. Where details were inadequate, the response was classified as unknown.
  • Some patients received other palliative treatment during radiotherapy, such as analgesia and steroids. Its influence on the effectiveness of radiotherapy is difficult to assess.

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, Pleura, Palliative Care, Dose-response relationship.

Related studies

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• Successful palliation for an aged patient with primary pericardial mesothelioma — R. Isoda, H. Yamane, et al. (2015)
• Re-evaluating the role of palliative radiotherapy in malignant pleural mesothelioma — P. Jenkins, R. Milliner, et al. (2011)
• High-dose palliative radiotherapy for malignant pleural mesothelioma — F. Foroudi, J.G. Smith, et al. (2017)
• Pleurectomy/decortication for palliation in malignant pleural mesothelioma: results of surgery — O. Soysal, N. Karaoğlanoğlu, et al. (1997)
• Mesothelioma--VATS biopsy and lung mobilization improves diagnosis and palliation — M.W. Grossebner, A.A. Arifi, et al. (1999)

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