Mesothelioma survival doubles with radical hemi-thoracic radiotherapy regimen
medwireNews: Switching palliative radiation for high-dose radical hemi-thoracic radiotherapy significantly increases 2-year overall survival among patients with a new diagnosis of malignant pleural mesothelioma, delegates were told at the ESTRO 38 meeting in Milan, Italy.
“This research shows a clear survival benefit in using this type of radiotherapy for mesothelioma patients whose tumours can only partially be removed by surgery,” commented presenting author Marco Trovo (University Hospital of Udine, Italy) in a press release.
“We believe that this should be considered the new standard of care for these patients,” he said.
The trial tested an image-guided intensity modulated radiotherapy regimen of 50 Gy in 25 fractions to the left or right side of the trunk, avoiding the intact lung, that was given alongside a 60-Gy dose in 25 fractions targeting residual disease after patients had undergone biopsy or partial or extensive pleurectomy, and systemic chemotherapy for stage I–IVA disease.
Overall, 2-year survival was achieved by 57.7% of the 55 patients who were randomly assigned to receive the radical hemi-thoracic radiotherapy but just 27.9% of the 53 controls given a conventional palliative regimen of 20–30 Gy delivered over 3–10 fractions that were directed at the thoracotomy scar or gross residual disease.
Trovo reported multivariate analysis demonstrating a survival benefit in favor of the radical hemi-thoracic regimen, with a significant hazard ratio (HR) for death of 0.41 versus palliative care after adjusting for a raft of confounding factors including age, sex, performance status, disease stage, and extent of surgery.
Patients were also significantly more likely to be alive at the 2-year mark if they had epithelioid versus nonepithelioid histology (HR=0.38), he said.
However, the presenter did note that “toxicity is not negligible” with the radical hemi-thoracic radiation approach, with around 20% of patients experiencing radiation pneumonitis, and one patient death attributed to this side effect. Other adverse events included grade 2–3 fatigue in 16 of the patients versus five of the controls.
Umberto Ricardi (University of Turin, Italy), president of ESTRO, described the research in a press release as being “an extremely positive result.”
“To ensure these patients benefit from this type of treatment, it’s important that they are referred to a specialist cancer centre with the right expertise and equipment to carefully plan and deliver the most effective radiotherapy treatment, and manage any side effects that occur,” he added.
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