Re-evaluating the role of palliative radiotherapy in malignant pleural mesothelioma

Our plain-English summary of Re-evaluating the role of palliative radiotherapy in malignant pleural mesothelioma, by P. Jenkins, R. Milliner, C. Salmon (European Journal of Cancer, 2011).

The study

• Authors: P. Jenkins, R. Milliner, C. Salmon
• Journal: European Journal of Cancer
• Published: 2011;47(14):2143-9
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: To determine the objective response rate of malignant pleural mesothelioma (MPM) to short course radiation therapy.

Methods: We reviewed the cases of 54 patients with advanced MPM who were treated with palliative radiotherapy according to a standardised institutional policy. Pre- and post-treatment computed tomography scans were used to assess response.

Results: Fifty-seven percent of patients reported some improvement in their symptoms following radiotherapy. The radiology response rate was 43% (22 patients had a partial response and 1 patient a complete response). Response to treatment was correlated with the European Organisation for Research and Treatment of Cancer (EORTC) prognostic index (p=0.001), performance status (p=0.02) and histological subtype (p=0.04). In the EORTC good prognosis group 56% of patients responded, compared with only 7% in the poor prognosis group (p=0.001). The median survivals from diagnosis and from the start of radiotherapy were 11.3 months and 5.2 months, respectively. Survival following treatment was correlated with the EORTC prognostic index (p<0.001), histological subtype (p<0.001), performance status (p=0.001), treatment response (p=0.002) and haemoglobin level (0.02). The EORTC good and poor prognostic groups had survivals of 7.1 and 2.1 months, respectively (p<0.001). Neither tumour volume nor stage were associated with prognosis.

Conclusions: Palliative radiotherapy produces a response rate in MPM that is equivalent to chemotherapy. The EORTC prognostic index can be used to select patients who are most likely to benefit from this treatment.

Copyright © 2011 Elsevier Ltd. All rights reserved.

In plain English

This was a retrospective review of 54 patients with advanced malignant pleural mesothelioma treated at the Gloucestershire Oncology Centre, UK, between January 2002 and December 2008. All received palliative radiotherapy (36 Gy in 12 fractions), most often for chest pain resistant to opiate painkillers. Treatment targeted symptomatic sites, bulky disease and disease near critical structures. The article does not discuss asbestos exposure. On CT scans at 2 months, 22 patients had a partial and 1 a complete response within the treated area (43% overall). Twelve patients could not be evaluated. Thirty-one patients (57%) reported symptom improvement, including 27 of 50 with chest pain. Median survival was 11.3 months from diagnosis (95% confidence interval 9.0 to 13.6) and 5.2 months from the start of radiotherapy (95% confidence interval 3.0 to 7.4). On the EORTC prognostic index, good-prognosis patients responded more often than poor-prognosis patients (56% versus 7%). They also lived longer after treatment (7.1 versus 2.1 months). Two patients had grade 3 side effects. The authors concluded the response rate was equivalent to chemotherapy, and said retrospective data should be viewed cautiously.

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 patients treated under a standard institutional policy (case series)
• Who was studied: 54 patients with malignant pleural mesothelioma (45 male, 9 female; median age 67, range 49–85), out of 195 referred to the Gloucestershire Oncology Centre, Cheltenham, UK, between January 2002 and December 2008
• Exposure: Palliative radiotherapy, 36 Gy in 12 fractions over 2.5 weeks. The target included sites of symptomatic disease, sites of disease bulk, and sites close to critical structures where progression would cause major symptomatic deterioration. Asbestos exposure is not addressed in the article.
• Main results:
  • Radiological response within the treatment field: 22 patients partial response, 1 complete response, overall response rate 43%. 15 patients (28%) had stable disease, 4 (7%) had progression, and 12 could not be evaluated.
  • Symptomatic response at 2 weeks was reported by 31 patients (57%). Among patients with chest pain, 27 of 50 responded.
  • Median survival from diagnosis was 11.3 months (95% confidence interval 9.0–13.6), with 44% alive at 1 year. Median survival from the start of radiotherapy was 5.2 months (95% confidence interval 3.0–7.4), with 19% alive at 1 year.
  • In the EORTC good prognosis group, 22 patients (56%) responded, compared with 1 (7%) in the poor prognosis group (p = 0.001).
  • Survival after radiotherapy was 7.1 months in the EORTC good prognosis group versus 2.1 months in the poor prognosis group (p < 0.001).
  • Patients who responded to radiation survived longer than non-responders (7.2 versus 2.8 months, p = 0.001).
  • Neither stage nor tumour volume was correlated with survival.
  • Toxicity was mostly mild. Only 2 patients developed grade 3 toxicity: one radiation pneumonitis and one nausea and vomiting.
• The authors' conclusion: The authors concluded that palliative radiotherapy produces a response rate in malignant pleural mesothelioma equivalent to chemotherapy, and that the EORTC prognostic index can be used to select patients most likely to benefit.
• Limitations the authors state:
  • The study was retrospective, and the authors said the data should be viewed cautiously.
  • Not all patients had post-treatment scans.
  • The durability of the response was not defined.
  • A significant volume of tumour was left out of the area treated.
  • Deciding which parts of the tumour caused symptoms or threatened function was subjective.
  • Many patients later developed malignant ascites from spread across the diaphragm.

Topics

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

Medical terms in this study, explained in our Lexicon: Palliative Care, Pleural Mesothelioma, Performance Status, Histological Subtype, Prognosis, Median Survival, Chemotherapy.

Related studies

• High-dose palliative radiotherapy for malignant pleural mesothelioma — F. Foroudi, J.G. Smith, et al. (2017)
• Survival after conservative (palliative) management of pleural malignant mesothelioma — N. Merritt, C.J. Blewett, et al. (2001)
• Nonselective transarterial chemoperfusion: a palliative treatment for malignant pleural mesothelioma — T.J. Vogl, S. Lindemayr, et al. (2013)
• Is Radiotherapy Useful for Treating Pain in Mesothelioma?: A Phase II Trial — N. MacLeod, A. Chalmers, et al. (2015)
• Palliative treatment of malignant pleural effusions — D. Horn, D. Dequanter, et al. (2010)
• Thoracoscopic palliative treatment of malignant pleural effusions: results in 273 patients — K. Arapis, R. Caliandro, et al. (2006)

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