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Use of Radiotherapy and Surgery in Pleural Mesothelioma Treatment
Extrapleural Pneumonectomy:
September 5, 2003 — Surgery followed by radiotherapy proved useful in pleural mesothelioma treatment, according to a recent study at Memorial Sloan–Kettering Cancer Center in New York (Int J Radiat Oncol Biol Phys. 2003 Aug 1; 56(5): 1319–26). The patients underwent an extrapleural pneumonectomy—surgery that removed portions of the lung, the pleura (the lining of the lung), and the diaphragm. In some cases, parts of the pericardium (the lining of the heart) were also removed. This procedure was followed by radiation treatment of the thorax or chest.
Thirty–five pleural mesothelioma patients took part in the study from 1990 through 2001. Their disease had progressed to different degrees or stages prior to surgery and radiotherapy. According to the International Union Against Cancer staging system (IUCC), four patients had stage I pleural mesothelioma, eleven had stage II, 19 had stage III, and one had stage IV. Stage I is the least advanced form in which the mesothelioma is in the membrane lining the chest (either the left or right pleura), and has not spread to the lymph nodes. By stage IV, the disease has advanced to bone or to lymph nodes on both sides of the chest, or to organs in the body such as the liver or brain.
The researchers found that high–dose radiation could be delivered to the cancerous areas, while limiting any doses to the heart, spinal cord, liver, and stomach. Some patients experienced nausea and vomiting, as well as skin rashes. Overall, however, the study showed that high–dose targeted radiation combined with an extrapleural pneumonectomy was a reasonable mesothelioma treatment that could be well–tolerated, according to the researchers.
An earlier study involved 88 pleural mesothelioma patients. Sixty–six of these patients received extrapleural pneumonectomies and five had pleurectomies (operations in which the pleura containing the tumor is removed). All received high–dose radiation treatment following their surgeries. The median survival was 33.8 months for those who had stage I and II tumors. Using radiotherapy and surgery in mesothelioma treatment improved the survival of these patients, who otherwise would be expected to live for eight or nine months.
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