Radiation Therapy for Mesothelioma: Uses, Evidence, and Future Directions

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• Role of Radiotherapy in Mesothelioma
• SAKK 17/04 Clinical Trial Results
• Palliative Radiation for Pain Relief
• Multimodality Treatment and Survival Data
• Future of Proton Therapy in Mesothelioma
• Full Transcript

Role of Radiotherapy in Mesothelioma

Radiation therapy is a critical component in the multidisciplinary approach to treating malignant pleural mesothelioma. Dr. Dean Fennell, MD, explains that radiotherapy has historically been used to complement both surgical interventions and systemic medical treatments. This integrated strategy aims to target the cancer from multiple angles. The goal is to improve local control of the disease and potentially enhance overall patient outcomes.

SAKK 17/04 Clinical Trial Results

Dr. Dean Fennell, MD, references the pivotal SAKK 17/04 study published in the New England Journal of Medicine. This was a robust randomized clinical trial investigating the efficacy of radiotherapy in mesothelioma. Dr. Fennell describes the trial's outcome as "robustly negative," meaning it did not demonstrate a significant survival benefit from the radiotherapy intervention. This landmark study has profoundly influenced clinical practice and research directions in mesothelioma treatment.

Palliative Radiation for Pain Relief

Despite mixed results for curative intent, radiotherapy holds unequivocal value in palliative care for mesothelioma. Dr. Dean Fennell, MD, emphasizes that patients experiencing pain from their disease can derive significant benefit. When a painful area of mesothelioma is accessible within a radiation field, targeted treatment can provide effective symptom relief. This application focuses on improving quality of life by managing pain, which is a common and debilitating symptom for many patients.

Multimodality Treatment and Survival Data

The use of radiotherapy in a multimodality setting to improve survival remains an area of active debate. Dr. Dean Fennell, MD, notes a lack of high-quality randomized data proving that the added value of radiation justifies its associated toxicity. He cites two major UK phase three trials, PIT and SMART, which failed to show clear evidence of improved survival. These results suggest a need to carefully reevaluate the role of radiotherapy within curative treatment protocols for mesothelioma.

Future of Proton Therapy in Mesothelioma

A promising future direction for radiation in mesothelioma involves proton therapy. Dr. Fennell identifies this as an exciting area of active investigation. The physical properties of protons allow for more precise radiation delivery, potentially minimizing damage to neighboring healthy lung tissue. This lung-sparing approach could control the mesothelioma while significantly reducing toxicity risks for patients. Dr. Dean Fennell, MD, anticipates that results from ongoing proton therapy studies may emerge within the next few years.

Full Transcript

Dr. Anton Titov, MD: Radiotherapy in mesothelioma. Radiation therapy has been used to complement both surgical and systemic medical treatment. In a New England Journal of Medicine review, you highlighted a clinical trial SAKK 17/04 in your recent mesothelioma review. When can radiotherapy help in mesothelioma treatment? And when is radiotherapy not really indicated for mesothelioma treatment at this point in time?

Dr. Dean Fennell, MD: That SAKK 17/04 study that you refer to was a really important study, a randomized trial that was robustly negative. However, radiotherapy for mesothelioma has had its value.

First of all, mesothelioma patients who clearly have pain seem to benefit if there's an area of disease that can be accessed within the radiation field. Offering radiation as a palliative treatment has real value for patients.

In terms of trying to improve survival, although radiotherapy is used in the multimodality setting, we do not yet have good quality randomized data to show that the added value of radiotherapy justifies its use over and above the toxicity that we might see with this additional modality of treatment.

We've had two big national randomized studies in the UK. One clinical trial was called PIT, and I believe the other was called SMART. Neither of these phase three clinical trials actually showed clear evidence of improved survival.

As such, I think we have to take a backseat, sit back, and think about where radiation is going to make an impact in mesothelioma.

One area that's quite exciting, when thinking about lung-sparing treatments, is whether toxicity to the lung is less with proton therapy. It's whether or not the power of protons can deliver impact to cancer.

Proton therapy may minimize damage to neighboring structures. It may provide a nice way of being able to control mesothelioma while at the same time minimizing the potential risks for patients.

So I think this is an area that's actively being investigated at the moment. We may see results over the next year or two or a few years.