Resection and IORT followed by three-dimensional conformal radiotherapy with or without adjuvant chemotherapy for malignant mesothelioma

Our plain-English summary of Resection and IORT followed by three-dimensional conformal radiotherapy with or without adjuvant chemotherapy for malignant mesothelioma, by D.M. Jablons, M. Roach, T. Jahan, et al (Frontiers of Radiation Therapy and Oncology, 1997).

The study

• Authors: D.M. Jablons, M. Roach, T. Jahan, R.B. Cameron
• Journal: Frontiers of Radiation Therapy and Oncology
• Published: 1997;31:140-5
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This was a pilot study at the University of California at San Francisco testing whether a combined treatment for malignant mesothelioma was feasible. Six patients were enrolled between August 1995 and September 1996. Five completed surgery and radiation and were analyzed: all men, mean age 64.4 years, with stage II disease of the predominantly epithelial subtype. Treatment was surgery removing the pleura while keeping the lung (pleurectomy/decortication), radiation during the operation (IORT), three-dimensional conformal radiotherapy of 40 to 65 Gy afterwards, and planned CAP chemotherapy. All five had surgery and IORT without major complications, stayed in hospital an average of 7 days, and had their pleural fluid controlled and breathlessness relieved. Mean survival was 8.2 months (range 4 to 12 months) at 1 year follow-up. One patient died by suicide at 4 months. Another died of peritoneal metastases at 11 months. Side effects included febrile neutropenia with chemotherapy in 2 patients and mild chronic chest pain in 2. Asbestos exposure was not studied. The authors said these early results suggest the treatments can be safely combined with acceptable early morbidity.

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: Pilot feasibility study of combined treatment (review of records of enrolled patients); small case series
• Who was studied: Six patients with malignant mesothelioma enrolled at the University of California at San Francisco from August 1995 to September 1996. Five completed surgery and all radiation and were analyzed. All were male, mean age 64.4 years (range 47 to 75), Butchart stage II, predominantly epithelial subtype. No pure sarcomatoid cases were included.
• Exposure: No asbestos exposure was studied; asbestos is mentioned only in the introduction. The study examined a treatment: radical pleurectomy/decortication with intraoperative radiotherapy (typically three fields, average 10 Gy per field, 6 to 9 MeV electrons), then 3-D conformal radiotherapy of 40 to 65 Gy starting 4 to 5 weeks after surgery, with or without adjuvant CAP chemotherapy (cytoxan, adriamycin and cisplatin).
• Main results:
  • All 5 patients underwent resection and IORT without major complications. Hospital stays averaged 7 days, and patients typically recovered to baseline performance status within 4 weeks.
  • All patients had definitive control of their pleural effusions and relief of preoperative breathlessness.
  • Mean survival among the 5 patients was 8.2 months (range 4 to 12 months) at 1 year follow-up.
  • One patient died by suicide at 4 months after the operation without clinical or radiological evidence of local disease. A second died of distant (peritoneal) metastases at 11 months without radiological evidence of local recurrence.
  • Of the patients eligible for chemotherapy, two completed two cycles. One refused, one died by suicide before therapy, and the fifth was receiving the first cycle at the time of writing.
  • Toxicities were febrile neutropenia with chemotherapy in 2 patients and a localized infected hematoma in another. Two patients developed a mild chronic pain syndrome in the operated chest. Mild radiation pneumonitis was seen in 1 patient, who had no symptoms.
• The authors' conclusion: The authors wrote that these early results suggest radical pleurectomy/decortication followed by IORT and 3-D conformal radiotherapy, with or without CAP chemotherapy, can be safely combined with acceptable early morbidity. They added that short-term survival compares favorably with other studies.
• Limitations the authors state:
  • Families of the two patients who died refused postmortem examinations, so local recurrence could not be checked histologically.
  • The authors describe the results as early, with only short-term follow-up.

Topics

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

Medical terms in this study, explained in our Lexicon: Intraoperative Radiation Therapy (IORT), Chemotherapy, Malignant Mesothelioma.

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