Postoperative radiotherapy has limited survival benefits for certain patients with malignant pleural mesothelioma (MPM) who have had surgery to remove the cancer, researchers said in a recent retrospective study, and they called for large-scale studies to evaluate the treatment.
Patients with MPM are often treated with several therapies, including radiation, surgery, and chemotherapy. Radiation is often used as an adjuvant, or auxiliary, therapy.
“Proper administration of postoperative radiotherapy is particularly challenging … because of technical difficulties related to the extent of the disease and the increased potential for pulmonary toxicities following a major surgery in the thoracic cavity,” the researchers wrote in “Role Of Postoperative Radiotherapy In The Management Of Malignant Pleural Mesothelioma,” published in the German journal Strahlentherapie und Onkologie.
A research team at Ain Shams University in Egypt analyzed data from 2,166 patients (median age 60) in the SEER (Surveillance, Epidemiology, and End Results) database who had been diagnosed with MPM between 2000 and 2013. Of those patients, 469 had undergone postoperative radiotherapy.
The team initially found that postoperative radiotherapy improved overall survival rates. But when the researchers stratified their results by MPM type (epithelioid, sarcomatoid, or biphasic), they found that the treatment was of limited benefit for patients with sarcomatoid MPM. Results showed that sarcomatoid MPM, nodal positivity (cancer that has spread to the lymph nodes, which are all over the body), and older age (70 and up) were all associated with worse survival rates.
These results should be interpreted carefully, the researchers said, because the study did not include information on the radiotherapy technique applied to each patient or whether they also received chemotherapy.
“Evidence from this analysis is insufficient on its own to routinely recommend postoperative radiotherapy for surgically resected MPM,” they wrote. “However, large-scale prospective clinical trials may be warranted to further evaluate this intervention in non-sarcomatoid histology.”