A new radiation therapy that was used after pleurectomy/decortication (P/D) surgery has shown to be more effective in extending the lives of mesothelioma patients when compared to those undergoing extrapleural pneumonectomy (EPP), a recent study reports.
According to the study, carried out by the Houston, Texas MD Anderson Cancer Center and Princeton Radiation Oncology, improved radiation techniques, such as the Intensity Modulated Radiation Therapy (IMRT), which have helped physicians move away from using EPP only, show positive results, making more aggressive surgery not as necessary as it once was.
“This would seem to continue the shift toward the less aggressive surgery,” said Daniel Gomez, of M.D.D., of MD Anderson. “The goal is to kill the disease and allow patients to still have high-quality lives.”
The research, conducted in New Jersey, included 24 mesothelioma patients who were patients at MD Anderson from 2009 to 2013. While at MD Anderson, the patients received P/D surgery in combination with IMRT. The patients were then compared with other patients who underwent EPP. All patients’ age, and nodal and chemotherapy status’ were matched to ensure the most accurate results.
The Dangers of EPP
EPP involves completely removing the affected lung, a portion of the diaphragm, and the lining of the heart and chest. This invasive surgery, although it helps remove/eliminate mesothelioma cancer tumors, is dangerous. P/D, on the other hand, only removes the lining surrounding the lungs, then physicians carefully remove the growing mesothelioma tumor masses.
P/D Helps to Extends Lives
Both types of surgeries (EPP and P/D) are still used on mesothelioma patients in the United States. In fact, there have been debates as to which one is the most effective. However, a big difference lies within patient survival rates.
While the survival rate for the the EPP group was 14.2 months, it was extended for the P/D group at 28.4 months. The progression-free survival rate for the EPP group was 8.2 months, whereas it was 16.4 months for those in the P/D group.
The Donwside of P/D
Although P/D helps mesothelioma patients live longer, there is unfortunately one down side to the treatment. According to the results, P/D produces a small amount of high-grade toxicity, which in turn reduces pulmonary function. In fact, researchers noticed that there was a 19% pulmonary decline prior to IMRT. Post IMRT, there was a 29% decline.
“There is definitely a trade-off,” said Gomez. “This is not a panacea for treatment. The decline in pulmonary function is inevitable because the area being treated.”
However, Gomez went on to say that regardless of the pulmonary decline, there have been breakthrough advances in radiology. He feels that the new type of treatment will prove extremely beneficial.
“Radiation therapy has come a long way,” Gomez stated. “In the past, there were very limited options in terms of local control of the disease. I think our results showed that this technique after a pleurectomy can be very beneficial.”
Closely resembling EPP, the average interval time between IMRT and P/D was a little over one month. In a follow-up study, the average interval between the analysis and the surgery was a little over a year, which is four months longer than EPP.
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Chance, W., M.D., Rice, D., M.D., et al. (2014, October 25). Hemithoracic Intensity Modulated Radiation Therapy after Pleurectomy/decortication for malignant pleural mesothelioma: Toxicity, Patterns of Failure, and a Matched Survival Analysis. International Journal of Radiation Oncology.