Mesothelioma Radiation Chemotherapy and Immunotherapy

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One interesting study is called, “Multimodality treatment of diffuse malignant pleural Mesothelioma” by Lambros S. Zellos, David J. Sugarbaker – Volume 29, Issue 1, Pages 41-50 (February 2002) – Seminars in Oncology.  Here is an excerpt: “Abstract – Diffuse malignant pleural mesothelioma (DMPM) is a challenging disease in all of its aspects, from presentation and diagnosis to staging and treatment. Single-modality therapy was the initial approach to this disease. It generally has not been effective in changing the natural history of DMPM. As a result, multimodality regimens involving surgery with radiation, chemotherapy, or immunotherapy delivered regionally or systemically have been evaluated. Randomized controlled studies comparing various strategies are lacking and, thus, the debate continues regarding the effectiveness of different treatment approaches.” Semin Oncol 29:41-50.

One interesting study is called, “Outcomes After Extrapleural Pneumonectomy and Intensity-Modulated Radiation Therapy for Malignant Pleural Mesothelioma” – The Annals of Thoracic Surgery – Volume 84, Issue 5, November 2007, Pages 1685-1693 by David C. Rice MB, BCha, Craig W. Stevens MD, PhD, Arlene M. Correa PhD, Ara A. Vaporciyan MD, Anne Tsao MD, Kenneth M. Forster PhD, Garrett L. Walsh MD, Stephen G. Swisher MD, Wayne L. Hofstetter MD, Reza J. Mehran MD, MS, Jack A. Roth MD, Zhongxing Liao MD and W. Roy Smythe MD – Here is an excerpt: “Background – Malignant pleural mesothelioma is a locally aggressive tumor that is usually fatal. Extrapleural pneumonectomy (EPP) followed by hemithoracic irradiation has shown promise, but local failure remains a significant problem. To improve local control, we have used intensity-modulated radiation therapy (IMRT) as it allows better dose distribution to regions at risk of recurrence as well as reduced radiation to surrounding organs.  Methods – One hundred consecutive patients underwent EPP. At a median interval of 2.5 months from surgery, 63 patients received IMRT (median dose 45 Gy) with curative intent. Chemotherapy was not routinely administered.

Results – Tumors were right sided in 66 patients (66%) and nonepithelioid in 33 (33%). American Joint Committee on Cancer pathology stage was I in 6 patients (6%), II in 7 (7%), III in 72 (72%), and IV (T4) in 15 (15%). Fifty-four patients (54%) had ipsilateral nodal metastases. Perioperative mortality was 8%. Median overall survival (n = 100) was 10.2 months. For patients who received IMRT (n = 63), median overall and 3-year survival was 14.2 months and 20%. Of these, node-negative patients with epithelioid histology (n = 18) had median and 3-year survival of 28 months and 41%. Distant recurrences occurred in 33 of 61 evaluable patients (54%). Eight patients (13%) had local or regional recurrence, 5 of whom also recurred distally. Only 3 patients (5%) had recurrence within the irradiated field.  Conclusions – Intensity-modulated radiation therapy after EPP results in excellent local control for malignant pleural mesothelioma; however, distant metastases remain a significant problem and limit survival. This provides a strong rationale for combining aggressive local regimens with systemic therapy.”

One study is called, “Radiotherapy in the treatment of malignant mesothelioma of the pleura, with special reference to its use in palliation” by S R Davis Fracr, L Tan Bsc, D L Ball Fracr – Australasian Radiology Volume 38, Issue 3, pages 212–214, August 1994.  Here is an excerpt: “SUMMARY – 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.”

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