Mesotheleoma, a rare but extremely lethal type of lung cancer affecting the lining of the lung, has always been a challenge to treat. A new study finds that extensive surgery (removal of the lung and the lining of the lung) followed by high dose radiation therapy is well tolerated, and may improve local disease control and survival rates.
About 2,200 cases of mesothelioma are diagnosed per year, the majority of which are caused by environmental exposure to asbestos.
"For many years we were unable to give too much radiation to the chest because of extreme toxicity, but new technologies and treatment techniques have helped us get around that," said Santosh Yajnik, MD, radiation oncologist at MSKCC and lead author of the study. One of the reasons doctors were able to give higher doses of radiation therapy to patients in this study was because the affected lung had been completely removed.
In the last four years, MSKCC has seen about 365 patients with mesothelioma, and approximately 63 patients were treated with this type of extensive surgery. This experience makes the Center one of only a handful of hospitals in the country with expertise in this area.
In this study, 32 patients with various stages of mesothelioma who had surgery at MSKCC between 1990 and 2000 were treated with high dose radiation therapy. The median overall survival was 17 months compared to median survival rates of about 12 months historically seen in patients who have surgery alone. Researchers noted that patients with earlier stage disease experienced better survival rates than those with late stage cancer. They also observed that patients tolerated the treatment well without suffering high levels of toxicity.
Four patients had local tumor recurrence, seven had local and distant recurrence, and nine patients had distant disease recurrence. "Now that we know radiation helps with local control, the next step is to study whether chemotherapy can further reduce mortality rates and improve distant control of the tumor," concluded Dr. Yajnik.
Radiation treatment for mesotheleoma.