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Radiotherapy for the treatment of pain in malignant pleural mesothelioma: a systematic review
N Macleod1, A Price2, N O'Rourke3
1Edinburgh Cancer Research UK Centre, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK; Beatson West of Scotland Cancer Centre, 1053 Great Western Rd, Glasgow G12 0YN, UK.
Abstract:
Radiotherapy is commonly used to treat pain in malignant pleural mesothelioma (MPM). The purpose of this systematic review is to examine the evidence for this practice. Medline (1946-2013), Embase (1974-2013) and Central (The Cochrane Library Issue 9, 2012) databases were searched. Eligible studies met the following criteria: MPM (histological or radiological diagnosis), radiotherapy given with the intent of improving pain, response rates to radiotherapy reported, dose and fractionation reported and the relationship between radiotherapy and pain response explored. All studies had independent review and were graded according to evidence level. Eight studies met the eligibility criteria. Two studies were prospective single arm phase II studies while the remainder were retrospective case series. All were graded as either Level 2 or Level 3 evidence. Due to marked heterogeneity among studies, quantitative synthesis of results was not possible. No high quality evidence currently exists to support radiotherapy in treating pain in MPM. Studies focusing on clear pain endpoints and improving target delineation are needed. Such studies should also use modern radiotherapy techniques and concentrate on dose escalation.
Insights
Radiotherapy is a common treatment for malignant pleural mesothelioma (MPM) pain. However, this review found no high-quality evidence to support its effectiveness in managing MPM-related pain.
Area of Science:
- Oncology
- Palliative Care
- Radiology
Background:
- Malignant pleural mesothelioma (MPM) is a rare and aggressive cancer.
- Pain management is a critical aspect of palliative care for MPM patients.
- Radiotherapy is frequently employed for symptom control in MPM, particularly for pain relief.
Purpose of the Study:
- To systematically review the existing evidence on the efficacy of radiotherapy for pain management in malignant pleural mesothelioma.
- To assess the quality of evidence supporting radiotherapy use in MPM pain.
- To identify gaps in current research and suggest future directions.
Main Methods:
- A systematic search of Medline, Embase, and Central databases was conducted (up to 2013).
- Eligible studies included MPM patients receiving radiotherapy for pain, reporting response rates, dose, and fractionation.
- Studies were independently reviewed and graded by evidence level (Level 2 or 3).
Main Results:
- Eight studies met the eligibility criteria, comprising two prospective phase II studies and six retrospective case series.
- Significant heterogeneity among studies precluded quantitative synthesis of results.
- No high-quality evidence was found to support the use of radiotherapy for pain in MPM.
Conclusions:
- Current evidence supporting radiotherapy for pain relief in malignant pleural mesothelioma is of low quality.
- Further research is needed, focusing on clear pain endpoints, improved target delineation, modern radiotherapy techniques, and dose escalation.
- High-quality studies are essential to establish the role of radiotherapy in managing MPM pain.
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