Tomotherapy Treatment for Mesothelioma

Background

Malignant mesothelioma of the pleura is one of the most challenging diseases to treat in oncology. It is often associated with previous exposure to asbestos many years in the past with the mean latency period between asbestos exposure and the development of mesothelioma being approximately 48 years. The disease most commonly presents in the fifth to seventh decade of life, and the natural history is one of relentless progression and eventual death in nearly all patients. It can metastasize to regional nodes and/or distant sites, but most of the morbidity and mortality comes from local disease in the chest, causing progressive constriction, and death from pulmonary insufficiency or infection. Common clinical manifestations can include pleural effusions, superior vena cava obstruction, dysphagia, and laryngeal nerve palsy. Median survival rates are generally less than one year from the time of diagnosis, although there may be a small subset of patients with more indolent disease that have longer survival durations. Patients generally suffer from significant symptoms over the course of their illness, particularly progressive dyspnea and chest pain.

Treatment options with mesothelioma

The treatment of mesothelioma has been characterized by disappointment. The only form of "curative" treatment that has been attempted is a combination of surgery (extrapleural pneumonectomy), chemotherapy, and radiation treatment to the hemithorax. This was described by Sugerbaker, who reported 5-year survival rates of 22% of 120 patients treated. Unfortunately, this approach is only possible for early stage disease (clinical stage I with no nodal involvement) in the absence of comorbid medical illness, and the vast majority of patients present with disease too advanced to consider this approach.

Role of radiotherapy in malignant mesothelioma: