Author of

• 12736

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  P3.14 - Poster Session 3 - Mesothelioma (ID 197)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Mesothelioma
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12742

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    P3.14-006 - Radiotherapy for the treatment of pain in Malignant Pleural Mesothelioma: A Systematic Review (ID 1586)

    09:30 - 09:30  |  Author(s): N.J. Macleod
    • Abstract

    Background
    To examine the evidence base for radiotherapy in the treatment of pain in malignant pleural mesothelioma.

    Methods
    A systematic search of the Medline (1946-2013), Embase (1974-2013) and Central (The Cochrane Library Issue 9, 2012) databases was performed looking for studies which evaluated the role of radiotherapy for pain relief in people with malignant pleural mesothelioma (MPM). Studies were included if MPM was radiologically or histologically diagnosed, radiotherapy was given with the intent of improving pain and response rates to radiotherapy were reported. Documentation of the dose and fractionation of radiotherapy that was given was required. Finally, the study must have explored the relationship between radiotherapy and pain response. Systematic reviews were ineligible.

    Results
    Nine studies were eligible. There was marked heterogeneity among studies so quantitative synthesis of results was not possible. The most recent study reported a clinical response rate of 54% two weeks after radiotherapy given at a dose of 36 Gray (Gy) in 12 fractions. This was targeted at the area of MPM that was felt to be causing the pain. However, this assessment was performed retrospectively. A radiological response of 43% measured via CT scanning two months after irradiation was also reported in this study. Another study reported a superior response rate (50%) for those treated with a 4 Gy fraction size compared with those treated with a fraction size of less than 4 Gy (39%). However, this was not randomised and reflected a change in policy to treat sites of symptomatic disease only rather than covering the entire volume of disease. A further study suggested a benefit to hemi-thoracic irradiation at a dose of 30 Gy in 10 fractions. However, Cobalt machines were used in this study. Another study suggested no benefit to hemi-thoracic irradiation at a dose of 40 Gy in 20 fractions. However, 27 of the 47 patients in this study had no pain at study baseline. The other studies in this review report varying response rates, primarily reported in a retrospective fashion.

    Conclusion
    There are no high quality data to support the use of radiotherapy for pain management in MPM. Studies focusing on clear pain endpoints, improving target delineation and delivering higher equivalent doses using modern day radiotherapy are needed. Biomarkers which may predict response in a proportion of patients should be sought.