Allan Price1. 1. Edinburgh Cancer Centre, Edinburgh, UK. aprice@staffmail.ed.ac.uk
Abstract
OBJECTIVE: A review of the evidence supporting the use of radiotherapy in patients with mesothelioma was performed. METHODS: Relevant publications were searched for on Medline. RESULTS: In a Medline search on radiotherapy and mesothelioma, 611 hits were obtained. A limited number of prospective phase II trials of radiotherapy as part of trimodality protocols for early disease and in the palliation of pain were found, along with three small randomized controlled trials of port-site prophylaxis. CONCLUSION: No randomized data exist to support the use of radiotherapy after radical surgery, although there are a large number of publications describing its use as an integral part of therapy, including seven phase II studies. One ongoing trial is randomizing patients to radiotherapy or not after extrapleural pneumonectomy. None of these studies provided any assessment of radiotherapy independent of the other modalities investigated, nor did any formally assess intensity-modulated radiotherapy. There have been several reports of excessive toxicity with this technique, and its use should be limited to phase I studies until the basis of this toxicity is better understood. Three trials have looked at port-site prophylaxis, one supporting its use and two showing no evidence of benefit. Two studies addressed pain control prospectively, one showing definite but short-lived benefits. Implications. Radiotherapy is widely used in treating mesothelioma with little supporting evidence. More randomized trials are required to justify this use in all three common settings for its use.
OBJECTIVE: A review of the evidence supporting the use of radiotherapy in patients with mesothelioma was performed. METHODS: Relevant publications were searched for on Medline. RESULTS: In a Medline search on radiotherapy and mesothelioma, 611 hits were obtained. A limited number of prospective phase II trials of radiotherapy as part of trimodality protocols for early disease and in the palliation of pain were found, along with three small randomized controlled trials of port-site prophylaxis. CONCLUSION: No randomized data exist to support the use of radiotherapy after radical surgery, although there are a large number of publications describing its use as an integral part of therapy, including seven phase II studies. One ongoing trial is randomizing patients to radiotherapy or not after extrapleural pneumonectomy. None of these studies provided any assessment of radiotherapy independent of the other modalities investigated, nor did any formally assess intensity-modulated radiotherapy. There have been several reports of excessive toxicity with this technique, and its use should be limited to phase I studies until the basis of this toxicity is better understood. Three trials have looked at port-site prophylaxis, one supporting its use and two showing no evidence of benefit. Two studies addressed pain control prospectively, one showing definite but short-lived benefits. Implications. Radiotherapy is widely used in treating mesothelioma with little supporting evidence. More randomized trials are required to justify this use in all three common settings for its use.
Authors: Aaron M Allen; Maria Czerminska; Pasi A Jänne; David J Sugarbaker; Raphael Bueno; Jay R Harris; Laurence Court; Elizabeth H Baldini Journal: Int J Radiat Oncol Biol Phys Date: 2006-07-01 Impact factor: 7.038
Authors: Yee C Ung; Edward Yu; Conrad Falkson; Adam E Haynes; Denise Stys-Norman; William K Evans Journal: Radiother Oncol Date: 2006-07-03 Impact factor: 6.280
Authors: E H Baldini; A Recht; G M Strauss; M M DeCamp; S J Swanson; M J Liptay; S J Mentzer; D J Sugarbaker Journal: Ann Thorac Surg Date: 1997-02 Impact factor: 4.330
Authors: Maria F Chan; Chen S Chui; Yulin Song; Chandra Burman; Ellen Yorke; Cesar Della-Biancia; Kenneth E Rosenzweig; Karen Schupak Journal: Radiother Oncol Date: 2006-05-15 Impact factor: 6.280
Authors: D J Sugarbaker; J P Garcia; W G Richards; D H Harpole; E Healy-Baldini; M M DeCamp; S J Mentzer; M J Liptay; G M Strauss; S J Swanson Journal: Ann Surg Date: 1996-09 Impact factor: 12.969
Authors: Nico van Zandwijk; Christopher Clarke; Douglas Henderson; A William Musk; Kwun Fong; Anna Nowak; Robert Loneragan; Brian McCaughan; Michael Boyer; Malcolm Feigen; David Currow; Penelope Schofield; Beth Ivimey Nick Pavlakis; Jocelyn McLean; Henry Marshall; Steven Leong; Victoria Keena; Andrew Penman Journal: J Thorac Dis Date: 2013-12 Impact factor: 2.895