Doctors at the Swedish Cancer Institute in Seattle are now confirming that radiation therapy given before mesothelioma surgery is better for some patients than giving it to them afterward.
Not long ago, the mesothelioma treatment center began offering preoperative radiation to complement its traditional package of surgery with either or both chemotherapy and postoperative radiation.
Preoperative radiation for mesothelioma surgery is a technique pioneered by researchers at Canada’s Princess Margaret Cancer Centre in Toronto.
Writing in the Jan. 20 online edition of the Journal of Thoracic Oncology, the Princess Margaret team told of mesothelioma survival rates doubling in response to preoperative radiation.
The Swedish Cancer Institute expects to see similar gains.
Already, it’s reporting that patients receiving preoperative radiation are experiencing survival rates better than anything the center has previously seen for malignant pleural mesothelioma.
Streamlined Mesothelioma Care
But the primary reason for offering preoperative radiation is to streamline care.
Thoracic surgeon Alexander Farivar, M.D., Swedish Cancer Institute’s surgical director of pleural diseases, says that qualifying patients not only receive radiation before surgery but they also receive it in a much shorter course.
Previously, radiation was administered over the course of a month, he explains. This new way of doing it delivers the radiation in just five days.
“Streamlining has obvious advantages for the patient and family during treatment,” says Farivar, a holder of certifications from the American Board of Surgery and American Board of Thoracic Surgery.
“Patients travel from far distances to come see us, so this has made the whole experience easier to undergo in all respects,” he adds.
Farivar notes that this new approach may also spare patients months of having to undergo chemotherapy.
Only One Type of Appropriate Mesothelioma Surgery
Unfortunately, not all patients are candidates for this treatment, he cautions.
Ideal candidates must be strong enough to tolerate the surgery — and the only surgery appropriate is extrapleural pneumonectomy.
Extrapleural pneumonectomy — EPP — is very hard on the body. It typically involves removing all of the pleura, one lung, the diaphragm and the pericardial sac.
The reason why only an EPP is appropriate is because the involved organs receive very high doses of radiation. Afterward, if those irradiated organs are not soon removed, the patient develops serious complications.
The most serious of those complications is radiation pneumonitis.
EPP is the one procedure that gets those “hot” organs out of the body so that radiation pneumonitis and other complications don’t have a chance to set in.
In comparison, a pleurectomy or decortication procedure would be inappropriate because the irradiated organs remain in the body after surgery.
The Swedish Cancer Institute has a reputation for offering patient-centered care, so the adoption of a procedure to streamline treatment for the benefit of mesothelioma victims and their loved ones comes as no surprise.
“This is something our mesothelioma program team at Swedish is incredibly excited about,” says Farivar, whose own philosophy of care is to offer compassionate and individualized attention to every patient.
