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Adjuvant Radiotherapy Does Not Improve Survival in Pleural Mesothelioma Patients

Published: June 11, 2021

Adjuvant radiotherapy might not be the best treatment for mesothelioma sufferers because researchers at Duke and Stanford found that this therapy does not help patients live longer. The researchers analyzed a database of pleural mesothelioma patients at Duke and a national registry of patients. The research looked at the outcomes of patients with radiation after surgery and compared them to patients who did not receive radiation. Radiation has the ability to reduce symptoms in certain patients, but the researchers found that it will probably not extend the lives of patients.

Radiation is a standard treatment for many different types of cancer, but it cannot be used effectively for mesothelioma since it has an irregular shape and is very aggressive. Pleurectomy and decortication surgery is the best option for patients, where the pleural membrane is removed alongside any other tumors. Sometimes doctors use extrapleural pneumonectomy surgery where a lung is removed as well. Radiation is usually given as adjuvant therapy, with patients receiving it after a surgical procedure to kill remaining cancer cells left behind by surgeons. It can also be used to slow the growth of tumors and reduce fluid buildup.

The study looked at patients with Stage I, II, and III pleural mesothelioma. There were 212 patients from Duke from the years 1996 to 2016 and 1,615 patients from the National Cancer Database from 2004 to 2015. The patients who underwent adjuvant radiotherapy had more advanced cancer progression and had no signs of cancer where the tumor was removed. From 4.4 to 4.5 months after surgery, the patients who received adjuvant radiotherapy did not have an improved survival compared to the patients not receiving any radiation. The Duke patients who received adjuvant chemotherapy also had similar recurrence rates, showing that radiotherapy does not do much for patients in terms of survival. The cancer grow back rate was also similar. Half of the patients had mild side effects but some of the patients (1 in 5) had severe complications due to the procedure. With this information, doctors can now prevent patients from doing useless treatments with harmful side effects.

Mesothelioma is a cancer of the mesothelial tissue, which is tissue that surrounds certain organs. One type, the pleura, is the most common to develop mesothelioma after asbestos exposure. Once the fibers are inhaled, they become lodged in the tissue and cause DNA changes, turning normal cells into cancer cells. Mesothelioma is an aggressive cancer with no cure, but researchers are hopeful that with more research, a cure can be found.

Vignesh Raman et al., “The Impact of Adjuvant Hemithoracic Radiation on Outcomes in Patients with Stage I-III Malignant Pleural Mesothelioma” Annals of Surgery (June 4, 2021). [Link]
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