PrintRequest Information
Effect of IMRT Radiation Following the Mesothelioma Surgery Known as “Extrapleural Pneumonectomy”
April 1, 2005 — Mesothelioma patients who have operations known as extrapleural pneumonectomies and then receive IMRT radiation treatment may develop unusual patterns on their CT or CAT scans that suggest liver injuries, according to a study at the Anderson Cancer Center in Texas (AJR 2005; 184: 1091–1095). Although liver function may remain fairly normal, the CT scan may show a band–like section at the edge of the liver, the researchers found. Knowing about the typical location and appearance of this image can prevent doctors from assuming that the mesothelioma tumor has recurred or spread, the researchers said. They also noted that because the liver is so close to the chest and lung area, radiation injury to the liver cannot be completely avoided at times.
IMRT or intensity–modulated radiation therapy is a computer–assisted process that aims small radiation beams at tumors from various angles. The beam shape and intensity changes many times during the treatment. The radiation intensity is controlled so that higher radiation levels are delivered to the tumor. IMRT is considered more precise than standard radiotherapy. It also has a better record of allowing technicians to treat irregularly shaped tumors and to avoid injury to other organs that are close by. See How IMRT Works (Mayo Clinic).
In this study, twenty patients with an average age of 59 years received IMRT radiation after their extrapleural pneumonectomies. Treatment with radiation was delivered in 25 fractions over 5 weeks. CT scans showed that the patients’ livers were normal prior to the radiation treatment.
After radiation treatment, CT scans showed that eight patients (40%) had band–like regions on the edge of their livers, which corresponded to areas that had received some radiation. Patients with these abnormalities did not have symptoms of liver problems however, and the results of their liver function tests were normal. In four of the eight patients, the appearance of the liver eventually returned to normal on CT scans.
Mesothelioma and Extrapleural Pneumonectomy
An “extrapleural pneumonectomy” is surgery that removes portions of the lung, the parietal pleura (the lining of the lung), the pericardium (the lining of the heart), and the diaphragm. It removes more tumor cells than other surgical procedures do. Usually, the surgery is indicated in the earlier stages of mesothelioma, when the patient still has good enough heart and lung function to withstand its rigors.
In another study done at Anderson Cancer Center, twenty–eight patients who had undergone extrapleural pneumonectomies were treated with IMRT (Cancer J. 2003 Nov–Dec;9(6): 476–84). After about 9 months of follow–up, control of the original mesothelioma tumor area was 100%. The one year survival rate was 65%. Common side effects included nausea, vomiting, and shortness of breath.
Brigham and Women’s Hospital and Dana–Farber Cancer Institute in Boston have a program for mesothelioma patients that combines extrapleural pneumonectomy, radiation therapy, and chemotherapy. Prior studies have shown some success in prolonging survival using these combined methods (J Thorac Cardiovasc Surg 1999; 117:54–65; Chest. 1999;116:450S–454S). However, the surgery is not without its critics. Some doctors believe that the risks of extrapleural pneumonectomy are too great. These include internal bleeding, respiratory failure, pneumonia, emphysema (accumulation of pus in the chest cavity), and deep vein thrombosis (blood clotting in the veins of the inner thigh or leg).
For more information about mesothelioma treatment using extrapleural pneumonectomy and other surgical techniques, see Mesothelioma Treatment: Surgery and Fluid Removal. You may also visit the Brigham and Women’s Hospital web site for a web cast of an extrapleural pneumonectomy performed by the renowned surgeon, Dr. David Sugarbaker. If you would like to know about your legal rights concerning mesothelioma, please feel free to contact us at Brayton Purcell. We have been handling cases involving mesothelioma and asbestos exposure for over 20 years and can provide support, information, and excellent advocacy.
Print