Systematic review
The role of radiation therapy in malignant pleural mesothelioma: A systematic review

https://doi.org/10.1016/j.radonc.2006.06.002Get rights and content

Abstract

Introduction

Radiation therapy may offer patients presenting with malignant pleural mesothelioma (MPM) symptom palliation and improvements in quality of life. This systematic review will address the role of radiation therapy in the management of MPM.

Methods

A thorough systematic search of the literature was conducted for published articles and conference proceedings for applicable abstracts. Relevant trials were selected and assessed.

Results

Three small randomized controlled trials compared prophylactic external beam radiation therapy to no radiation therapy for patients with thoracic tracts caused by drainage tubes or diagnostic procedures. None of those trials reported any serious adverse effects. A pooled analysis found no significant reduction in the frequency of procedure tract metastases. Four non-comparative studies have shown that hemithoracic irradiation alone resulted in significant toxicity, including radiation-induced pulmonary fibrosis, radiation pneumonitis, and bronchopleural fistula, without any survival benefit. Few of the identified studies reported on symptom control, and no studies included formal measures of quality of life.

Conclusion

There is limited evidence for the role of radiotherapy in the management of patients with MPM. Future studies including radiotherapy for the treatment of such patients should include formal measures of quality of life and symptom control.

Section snippets

Methods

This systematic review was developed by Cancer Care Ontario’s (CCO) Program in Evidence-based Care (PEBC) and forms the basis for a practice guideline. Evidence was selected and reviewed by three members of the Lung DSG. Practice guidelines developed through the Program use the methods of the Practice Guidelines Development Cycle [7], and are available on the PEBC section of the CCO Web site at http://www.cancercare.on.ca/. This review has been edited and condensed for publication, but the

Literature search results

No meta-analyses were found for this topic. Three randomized trials [5], [8], [23] and four non-randomized, prospective trials [16], [19], [21], [25] met the eligibility criteria for this systematic review. The randomized trials compared prophylactic radiation therapy with no radiation therapy after thoracoscopy [5]; thoracic drainage tube removal [22], [23]; or fine needle aspiration, Abrams needle biopsy, thoracoscopy, or thoracic drainage tube removal [8]. Twelve non-randomized prospective

Discussion

Patients with MPM generally have a poor prognosis, and most will succumb to their disease within 3–5 years of diagnosis. Therefore, it is important to examine not only treatments administered with a curative intent but also those given with a palliative intent.

At the present time, there is no evidence to support the use of radical radiation therapy alone, administered with curative intent, in the management of patients with MPM. The only randomized trials of radiation therapy for patients with

Conclusions

Based on the lack of evidence for the use of radical radiation therapy alone in the management of patients with MPM, radical radiation should not be offered as a curative treatment option to patients with MPM. Palliative radiation therapy may offer short-term symptom control; however, long-term control has not been demonstrated. This lack of evidence is particularly disappointing considering the poor prognosis of this disease and the need for therapies that can improve the survival and quality

Acknowledgements

The Program in Evidence-based Care is sponsored by, but editorially independent of, Cancer Care Ontario and the Ontario Ministry of Health and Long Term Care.

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    Conflict of interest statement. The members of the Lung DSG disclosed potential conflicts of interest relating to the topic of this systematic review. The authors of this guideline declared that there were no conflicts of interest.

    1

    See the Program in Evidence-based Care section of Cancer Care Ontario’s Web site (http://www.cancercare.on.ca/) for a list of current Disease Site Group members.

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