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Researchers Say Adjuvant Radiotherapy Improves Survival for Early Stage Mesothelioma Patients

Malignant pleural mesothelioma (MPM) is an aggressive cancer caused by exposure to asbestos. While exposure often occurs in the workplace and most often in men, because many structures in the U.S. still contain asbestos, exposure is possible just about anywhere.

Affecting thousands of Americans each year, the disease is elusive as symptoms are similar to many other conditions. Making matters worse is MPM can take decades to develop from first exposure, meaning the disease is often diagnosed in its later stages, making it extremely difficult to treat. The good news is, today’s doctors and researchers are working hard to develop tools designed to catch the disease sooner. Close monitoring through medical history, imaging tests, and even blood tests is just one option.

For people who are known to have been exposed to asbestos, the American Cancer Society says “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.”

These tools, combined with the patients self-monitoring, 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 often a component of multimodality therapy, which may also prolong survival.

In the study, researchers say the National Cancer Database (NCDB) was queried to identify patients with MPM who received cancer-directed surgery between 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 with the following results:

“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.”

Adjuvant radiation was associated with improved survival among those with pathologic stage I–II MPM, the researchers concluded. No survival advantage was observed for those with pathologic stage III or stage IV MPM. 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 any symptoms, your doctor can refer you to a specialist who will assess your risk and set up a monitoring plan that could help detect mesothelioma sooner. Early detection could lead to better treatment options and longer survival. 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.