From the blog

Radiation Does Not Improve Survival in Pleural Mesothelioma Patients

Published: August 13, 2021

A study at the Duke University Medical Center has found that radiation does not extend survival in pleural mesothelioma patients. A dual registry analysis was performed to determine the effectiveness of aggressive surgery and radiation. Adjuvant radiation is recommended as a treatment by many cancer centers including the U.S. National Comprehensive Cancer Network and the European Society for Medical Oncology for mesothelioma, but Duke is challenging this belief with its report. Radiation was not associated with increased survival. Rather, it was associated with increased toxicity. Adjuvant radiation is typically used alongside surgery and chemotherapy when patients have early-stage disease. Another study in Switzerland also found that patients who underwent adjuvant radiation did not see a survival benefit. Even with radiation not adding a survival benefit, it is still recommended in patients with mesothelioma.

There were 212 patients in the study from the Duke Registry and 1,615 from the National Cancer Database registry. The outcome of receiving surgery with and without radiation were compared. There were 61 patients in the Duke registry who received radiation and 151 who did not. In most of the cases, intensity modulated radiation therapy (IMRT) was used. There were 426 patients from the National Cancer Database who received radiation while 1,189 patients from the registry did not. People in both registries did not see a survival benefit at 4.4 months for the Duke registry and 4.7 months for the National Cancer Database. The Duke registry also had patients with a similar incidence of recurrence, time to local recurrence, and overall recurrence as the patients who did not receive radiation.

Unadjusted local recurrence did have a different value when comparing people who received radiation with those who did not. Thirty-nine percent of the adjuvant radiation receivers had local recurrence versus 63 percent who did not. This does not affect the overall survival though. Radiation can help local control, but it does not affect the progression of disease enough to extend patient survival. Studies show that local recurrence after patients receive radiation is rare, but disease spread is very common, which is the main contributor to survival. Within the Duke group of people who had complete or near complete disease removal, 67 percent that received radiation had recurrence before the landmark time while 64 percent who did not receive radiation had recurrence before the landmark time.

Radiation toxicity needs to be considered when treating cancer patients. The study considered toxicity events when researching radiation effectiveness on patients. There were 21 patients in the Duke group with grade three or four events and more than 100 with grade one or two events. Over 80 percent of the patients had at lease one negative side effect because of radiation. Patients had nausea, emesis, and fatigue which could have impaired nutrition, function, and wound healing and immunity, leading to worse problems in the future.

“The Impact of Adjuvant Hemithoracic Radiation on Outcomes in Patients with Stage I-III Malignant Pleural Mesothelioma: A Dual Registry Analysis” Annals of Surgery (June 4, 2021). [Link]
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