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Study: Adjuvant Radiotherapy Effective Against Early Stage Mesothelioma

Malignant pleural mesothelioma (MPM) is an aggressive cancer that affects thousands of Americans each year. Caused by exposure to asbestos, the disease can take years to develop from first exposure and decades from first exposure to diagnosis. Because it has such a long latency period, mesothelioma is often diagnosed in the later stages, making it extremely difficult to treat. However, today’s doctors and researchers are working hard to alter the trajectory of the disease, with “close monitoring” fast becoming one of the most valuable tools.

According to the American Cancer Society, “for people who are known to have been exposed to asbestos, some doctors recommend regular imaging tests, like chest x-rays or computed tomography (CT) scans, to look for changes in the lungs that might be signs of mesothelioma or lung cancer.”

Doctors have also found that “people with mesothelioma have high levels of certain substances in their blood, including fibulin-3 and soluble mesothelin-related peptides (SMRPs). Researchers continue to study how blood tests for these substances might help find mesotheliomas early, as well as how they might be used to monitor the course of the disease in people who have mesothelioma.”

When combined with the patient’s diligence, these tools could help detect mesothelioma much sooner. Early detection could lead to better treatment options and outcomes. Researchers say one treatment option, known as adjuvant radiotherapy, appears to be effective in treating early state mesothelioma, with improved survival in patients. Adjuvant therapy is used in conjunction with other therapies (multimodality therapy), which may also prolong survival.

In the study called “Defining the role of adjuvant radiotherapy for malignant pleural mesothelioma: a propensity-matched landmark analysis of the National Cancer Database,” researchers say the NCDB was queried to identify patients with MPM who received cancer-directed surgery during the nine-year period from 2004–2013. “Adjuvant radiation included intensity modulated radiation therapy or conformal 3D radiation. Propensity matching was performed with a 150-day landmark to address survivorship bias. Cox regression was used with an interaction term between pathologic stage and radiation.”

A total of 2,846 patients were identified as having undergone cancer-directed surgery for MPM. Approximately 213 of these patients (7%) received adjuvant radiation. According to the research team:

“Adjuvant radiation was associated with improved survival among those who were stage I–II (P=0.024), but not stage III or IV (P=0.890 and P=0.183, respectively). After propensity matching, adjuvant radiation was associated with improved survival for those who were stage I–II [hazard ratio (HR) 0.52, P=0.035], whereas no similar effect was observed for those who were stage III or IV (P=0.190 and P=0.562, respectively). Multivariable regression revealed that sarcomatoid histology (HR 1.80, P=0.018) and stage IV disease (HR 1.65, P=0.033) were also associated with worse survival.”

Researchers concluded that adjuvant radiation was associated with improved survival among those with pathologic stage I–II MPM. No survival advantage was observed for those with pathologic stage III or stage IV MPM, however. Researchers say results of the study justify the need for further prospective trials to investigate the utility of adjuvant radiotherapy among those with MPM.

If you have been exposed to asbestos, see your doctor right away—even if you do not have symptoms. Your doctor can refer you to a specialist who will assess your risk and establish a monitoring plan that could help detect mesothelioma sooner. Early detection could lead to better treatment options and outcomes. See your doctor to assess your risk today.

 

Sources

“Can Malignant Mesothelioma Be Found Early?” American Cancer Society. American Cancer Society, Inc., 2019. Web. 09 Sep. 2019.

“Mesothelioma: Tests, Diagnosis, and Treatments.” WebMD. WebMD LLC., 2005-2019. Web. 09 Sep. 2019.

Nelson, David B., Rice, David C. and Kyle G. Mitchell. “Defining the role of adjuvant radiotherapy for malignant pleural mesothelioma: a propensity-matched landmark analysis of the National Cancer Database.” Journal of Thoracic Disease. AME Publishing Company, Apr. 2019. Web. 09 Sep. 2019.