Could Tri-Modality Treatment Extend Mesothelioma Survival?
Could tri-modality treatment extend mesothelioma survival? Based on an assessment of just over 200 mesothelioma cases, researchers at New York’s Memorial Sloan Kettering Cancer Center (MSKCC) believe the answer could be yes.
Led by Dr. Fauzia Shaikh, the research team analyzed 209 mesothelioma patients who underwent lung-sparing pleurectomy/decortication (P/D) and adjuvant radiotherapy (RT) for malignant pleural mesothelioma (MPM) between 1974 and 2015. Of the 209 mostly male patients with a median age of 64, 131 received adjuvant conventional RT (CONV) and 78 received hemithoracic intensity-modulated pleural RT or “IMPRINT.” Per the assessment, the primary end-point was overall survival (OS).
With IMPRINT, radiotherapy is confined to just one side of the chest (hemithoracic), making it more precise. IMPRINT is also dose-adjustable, so it may be manipulated to target the tumor and cancer cells, which helps avoid damaging healthy tissue. Conventional radiotherapy is designed to damage the DNA of cancer cells to make replication impossible. However, this type of therapy can damage normal cells, resulting in significant damage to healthy tissue.
To calculate OS, Dr. Shaikh and his team used the Kaplan-Meier method and Cox proportional hazards model to determine the amount of time it took the cancer to return and average length of survival in the IMPRINT vs. non-IMPRINT groups. Results showed patients receiving IMPRINT had significantly higher rates of the epithelial histological type, advanced pathological stage, and chemotherapy treatment. OS was significantly higher after IMPRINT (median 20.2 versus 12.3 months).
Higher Karnofsky performance score (the standard way of measuring the ability of cancer patients to perform ordinary tasks); having the epithelioid type of mesothelioma (about half of mesotheliomas are epithelioid—this type tends to have a better outlook (prognosis) than the other types), macroscopically complete resection (complete removal of the tumor), and use of chemotherapy/IMPRINT were found to be significant factors for longer OS in multivariate analysis. No significant predictive factors were identified for local failure or progression. Grade 2 or higher esophagitis developed in fewer patients after IMPRINT than after CONV (23% versus 47%).
The research team concluded that, trimodality therapy including adjuvant hemithoracic IMPRINT, chemotherapy, and the lung-sparing therapy P/D is associated with improved outcomes such as higher OS and lower rates of severe toxicity compared with P/D and CONV alone.
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"NCI Dictionary of Cancer Terms." National Cancer Institute (NCI), National Institutes of Health (NIH). U.S. Department of Health and Human Services (DHHS), n.d. Web. 14 June 2017.
Shaikh, Fauzia, MD, Marjorie G. Zauderer, MD, and Abraham J. Wu, MD. "Improved Outcomes with Modern Lung-Sparing Trimodality Therapy in Patients with Malignant Pleural Mesothelioma." Journal of Thoracic Oncology 12.6 (2017): 993-1000. Elsevier Inc. Web. 14 June 2017.