Interesting report from Italy, it mentions the use of EPP, which is now considered less attractive as an option in the the UK, due to the high degree of complications. However the Italian study is still interesting for its combination with radiotherapy – of course if you can undergo EPP, you’ve got to be pretty strong to start with, so not sure if these patients wouldn’t have survival in the upper range anyway.
A team of Italian researchers recently analyzed the records of 56 mesothelioma patients who had been treated with adjuvant radiotherapy after extrapleural pneumonectomy surgery (EPP) between 2005 and 2010. Extrapleural pneumonectomy is a radical surgical procedure that involves removing not only the mesothelioma tumors, but also the lung closest to the tumor and a portion of the diaphragm.
Although EPP is controversial due to its high rate of complications, a number of studies have shown it to increase survival, especially in carefully-chosen, otherwise healthy patients with the epithelioid type of mesothelioma.
Four of the EPP-treated mesothelioma patients in the retrospective Italian study were treated with Intensity Modulated Radiotherapy (IMRT,) and two with helical tomotherapy. The patients were all treated with 45 to 50Gy to the affected areas inside the chest. Twenty of the patients also got a simultaneous “boost” of 60Gy to the margins around the tumor in an effort to destroy any remaining mesothelioma cells.
For 90 percent of patients, the mesothelioma was kept under control in the region of the surgery for three years. Sixty-six percent of patients did not experience spread (metastasis) of their mesothelioma during that time. Fifty seven percent of patients were considered disease-free for at least three years.
