When a patient is diagnosed with mesothelioma, the goal of any sort of treatment regimen is to give them the best possible chance at extending their life. Historically, since mesothelioma is such an aggressive and rare form of cancer, there have been few attempts to conduct research into new and more effective ways of treating the disease. But with mesothelioma becoming more prominent in recent years, new studies using multi-modality treatments like radiotherapy are being conducted in the hopes of creating a more effective method of improving a patient’s prognosis.
Clinical Studies Support Adjuvant Radiotherapy
An adjuvant treatment is a procedure used to support and in addition to, the primary treatment for a disease. Treating mesothelioma, particularly pleural mesothelioma, with just radiation therapy has proven to be difficult given the wide area that the pleura (lung tissue) takes up in the body. This requires larger radiation fields which can increase toxicity in the patient’s body.
Adjuvant radiotherapy is almost always used in conjunction with surgical treatments such as a Pleurectomy with Decortication (P/D) or an Extrapleural Pneumonectomy (EPP), with varying degrees of success.
A study conducted by the radiation oncologist, Dr. Kenneth Rosenzweig, from Mount Sinai Hospital in 2017 showed that using adjuvant radiotherapy after a P/D procedure yielded more positive results than using radiotherapy in conjunction with an EPP surgery or undergoing surgery alone. This is promising given that many doctors are now favoring the P/D procedure over the EPP so as to spare as much of the lung as possible.
The study involved a cohort of patients diagnosed between 2004-2013 and was split into two groups. One group had surgery alone and the second underwent radiotherapy after the P/D operation. The results showed that those who underwent radiation treatment post surgery had a higher median survival rate of more than 21.4 months. Those who elected to only receive surgery had a median survival of 16.6 months. A significant margin that Dr. Rosenzweig made a point to state in the results and conclusions of the study.
Improving upon Radiation Therapy for Mesothelioma: IMRTs
Initial experiences with radiation therapy in the treatment of pleural mesothelioma proved to be less effective than other adjuvant treatments. This changed however with the development of a more refined process called Intensity Modulated Radiation Therapy (IMRT).
It is designed to administer a focused, high dose of radiation to the local tumor while delivering a less intense dose to surrounding healthy tissue. With this more precise radiation treatment available, it has opened the door for more studies to be conducted on the viability and overall success of IMRTs. Dr. Rosenzweig stated in his research report that:
“The use of RT has changed radically with the advent of advanced radiation treatment planning techniques, especially IMRT. IMRT is now part of the care for almost all patients when RT is used, despite the difficulties in some of the earliest studies.”
Along with IMRT being more precise, the ability of radiation oncologists to use a variable intensity radiotherapy also allows them to keep toxicity levels in the patient’s body to a minimum. This is essential for the recovery process, in the same way, being generally healthy can improve life expectancy after treatment. These factors determine how the patient is able to cope with the toll that these treatments take on the body.
The Future of Radiotherapy
As with any new technology or medical procedure, more research is required to help perfect the effectiveness of the treatment. The conclusion of the study conducted by Dr. Rosenzweig included the following:
“Recent studies in the use of IMRT show that the safety has improved with experience and has excellent efficacy in single institutional reports. Most of these studies are from centers with extensive experience in treating patients with malignant pleural mesothelioma and are able to develop expertise in the disease.”
Through the continued efforts of experts like Dr. Rosenzweig and new advances in radiation treatment like the IMRT, more patients will have access to these procedures. Open access will give researchers more data to work with while they continue to make these treatments more effective.
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