Radiotherapy for malignant pleural mesothelioma

Abstract

Background: Malignant pleural mesothelioma is a relatively uncommon disease, but the incidence is increasing and is expected to peak in many developed countries in the next two decades. The management of patients with malignant mesothelioma is controversial. Very few patients are suitable for any potentially curative treatment and the effectiveness of radical therapy with surgery, radiotherapy and/or chemotherapy in curing patients or prolonging survival is uncertain. The role of radiotherapy is controversial although it has been used as part of multimodal therapy. The present review will try to clarify these uncertainties. Objectives: To assess the effectiveness and safety of radiotherapy on patients with malignant pleural mesothelioma in any stage of the disease. Search methods: We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2008), MEDLINE (1966 to January 2009) and EMBASE (1974 to January 2009). We performed handsearches aimed at the identification of evidence by reviewing journals not indexed in databases, conference proceedings and/or scientific meetings. Selection criteria: We included all randomised controlled clinical trials using radiotherapy for malignant pleural mesothelioma in any stage, alone or combined with other therapies in patients of either sex and any age. We excluded studies without a control group. Data collection and analysis: No studies fulfilled the inclusion criteria. Main results: We found no reports of randomised comparisons of radiotherapy alone or combined for patients with malignant pleural mesothelioma. Authors' conclusions: As radiotherapy has never been compared to chemotherapy or surgery or to best supportive care (as part of combination therapy) in a prospective, randomised trial, there are no data to support one or the other treatment as a better option for patients with malignant pleural mesothelioma. There is a need for multicentre controlled randomised trials assessing the role of radiotherapy in the radical treatment of malignant pleural mesothelioma. The studies should be limited to patients with malignant pleural mesothelioma, classified by stage, cytology and type of radiotherapy. The type of radiotherapy should be defined in advance and variables of radiotherapy dose definition and delivery should be carefully controlled.