Experts have been debating whether radiotherapy combined with surgery for pleural mesothelioma patients is an effective treatment. An upcoming clinical trial hopes to clarify the benefits of such treatment.

Phase III clinical trial

The trial, sponsored by NRG Oncology, also involves the National Cancer Institute and is now in its third phase. It is the first trial of its kind, as a multicentre, randomised study measuring the potential survival benefits as well as the safety of intensity-modulated radiation therapy (IMRT) and pencil-beam scanning with pleurectomy and decortication surgery and chemotherapy.

Pleurectomy and decortication surgery

This is a two-part procedure. In a pleurectomy the surgeon opens the chest cavity and removes the lining of the lung, where the mesothelioma develops. The aim of this surgery is to alleviate symptoms caused by the build-up of fluid around the lungs, also known as pleural effusion. It also makes room for the lung to expand which in turn reduces chest pain.

In the decortication the surgeon aims to remove all of the tumour growth from the chest cavity.

It is a radical surgery and the whole procedure can take up to five hours to complete. During this time patients are under a general anaesthetic and so it is only a treatment option for those patients who are relatively fit and healthy, but for the mesothelioma.

Radiation treatment

Radiation therapy is often used in combination with surgery and chemotherapy to treat mesothelioma. It is seen as a good option as, unlike chemotherapy, the side-effects are generally minimal. However, there are questions over its effectiveness and there have been some cases of severe toxicities for pleural mesothelioma patients.

An important trial

The study hopes to enrol 150 pleural mesothelioma patients and it is hoped it will provide some much needed answer into the best way to treat mesothelioma. Dr Vivek Verma, a radiologist a Allegheny General Hospital said, “It will be an important trial. At this point, the role of radiation with mesothelioma is not entirely proven. It’s hard, with a rare cancer like this, to get adequately powered randomised studies to evaluate the benefit.”

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Patel, R. et al. (2020, February 20). Disease-Related Outcomes and Toxicities of Intensity-Modulated Radiation Therapy Following Lung-Sparing Pleurectomy for Malignant Pleural Mesothelioma: A Systematic Review.
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