Even though there is no cure for mesothelioma, there are many different treatment options for those suffering from this almost always fatal cancer. Palliative therapy has been successful in lessening symptoms and making the patient more comfortable. Chemotherapy, radiation therapy, and surgery are treatment methods that can be successful on their own, but in the end, there is no one overall treatment that can definitively provide the best results. Mesothelioma by nature is difficult to treat and patients will respond differently to different methods. Multimodality therapy is a treatment method take combines different treatments – incorporating chemotherapy, surgery, and radiation therapy to attack the cancer from multiple positions. One such treatment combines surgery, radiation and chemotherapy or photodynamic therapy and has found success in certain individuals suffering from mesothelioma. However, there is no overall agreement regarding its effectiveness. A study published in the Cochrane Database System Review aims to provide a more definitive answer on multimodality treatment.
Hoping to assess the benefits and harms associated with multimodality therapy, data was taken from the Cochrane Lung Cancer group’s Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase. Other studies, reviews, and conference proceedings were also reviewed. One hundred-four patients participated in two randomized clinical trials and their results were compared. Randomized control trials were evaluated and measured based on overall survival, progression-free survival (the cancer has not spread or gotten worse), or quality of life.
The first group received combined extrapleural pneumonectomy (EPP) and neoadjuvant platinum-based chemotherapy, or postoperative high-dose hemithoracic radiotherapy with combined EPP plus platinum-based chemotherapy. Overall survival in the non-radiotherapy group was 20.8 months, and 19.3 months in the group that included the radiotherapy treatment. In the second clinical trial comparisons were made concerning EPP plus postoperative hemithoracic radiotherapy with standard (non-radical) therapy alone following platinum-based chemotherapy. Results here showed overall survival at 14.4 months for those included with the non-radical therapy, and 19.5 months in those who were not.
Researchers from this study concluded that because the overall quality of life did not neem to greatly differ between groups and since the evidence gathered was not strong, there is not enough available evidence to support multimodality therapy use routinely, and it is recommended the treatment remain in clinical trials.
While this may not sound like positive news, it is important to remember that no two mesothelioma patients are alike. Multimodality therapy may not be a standard treatment across the board, but for certain mesothelioma patients, it can be the most effective. Through factors such as age, gender, length of diagnosis, and prognosis, doctors will be able to make an informed decision about which care will be able to have the best possible outcome.
Abdel-Rahman, et. al. “Radical Multimodality Therapy for Malignant Pleural Mesothelioma,” Cochrane Database System Review (January 8, 2018). [Link]