Creating a treatment plan for patients diagnosed with malignant pleural mesothelioma is a challenge. Though patients expect a standard course of treatment with proven results, the reality is that each patient is unique, and responds in different and unpredictable ways to different protocols. One example of this can be found in performing radiotherapy before mesothelioma surgery. Though some patients receive a benefit from the procedure, others suffer significant adverse effects. For one group of physicians, those effects are enough to have made them abandon the routine pre-surgical use of the modality.
Mayo Clinic Researchers Abandon Idea of Routine Pre-Surgical Radiotherapy
Writing in the journal Frontiers in Oncology, William G. Breen and his colleagues from the Mayo Clinic in Rochester, Minnesota report on studying the use of a protocol called SMART, or Surgery for Mesothelioma After Radiation Therapy, to pleural mesothelioma patients undergoing surgery. The theory behind the treatment is that radiation makes surgery more effective by decreasing the tumors’ size.
Though their research showed that the protocol achieved its principal goal, making the tumors smaller and easier to remove, many of the patients suffered such adverse effects that the researchers decided the risk was not worth the gains. Of five patients treated between 2016 and 2017, all five had good long-term outcomes in terms of their mesothelioma, but one developed such significant kidney problems that they had to go on dialysis, two developed atrial fibrillation, one required a breathing tube due to acute respiratory distress and one went on to require additional surgeries. These were all described as “significant treatment-associated morbidities.”
Other Studies of Radiotherapy in Mesothelioma Continue
Though the team from the Mayo Clinic opted out of using radiotherapy as a routine pre-surgical treatment, other researchers around the world continue to explore its uses, including a French team exploring use of a radiation therapy technique that is delivered more quickly and a Canadian trial exploring the specific use of radiotherapy prior to less-invasive lung-sparing procedures.
Writing of their findings, Breen and his team concluded, “SMART provided promising oncologic outcomes at the cost of significant treatment related morbidity. Due to the significant treatment associated morbidity and favorable treatment alternatives, we have not broadly adopted SMART at our institution.”
If you or someone you love is exploring treatment options for malignant pleural mesothelioma, the Patient Advocates at Mesothelioma.net can help. Contact us today at 1-800-692-8608.