Systematic reviewThe role of radiation therapy in malignant pleural mesothelioma: A systematic review☆
Section snippets
Methods
This systematic review was developed by Cancer Care Ontario’s (CCO) Program in Evidence-based Care (PEBC) and forms the basis for a practice guideline. Evidence was selected and reviewed by three members of the Lung DSG. Practice guidelines developed through the Program use the methods of the Practice Guidelines Development Cycle [7], and are available on the PEBC section of the CCO Web site at http://www.cancercare.on.ca/. This review has been edited and condensed for publication, but the
Literature search results
No meta-analyses were found for this topic. Three randomized trials [5], [8], [23] and four non-randomized, prospective trials [16], [19], [21], [25] met the eligibility criteria for this systematic review. The randomized trials compared prophylactic radiation therapy with no radiation therapy after thoracoscopy [5]; thoracic drainage tube removal [22], [23]; or fine needle aspiration, Abrams needle biopsy, thoracoscopy, or thoracic drainage tube removal [8]. Twelve non-randomized prospective
Discussion
Patients with MPM generally have a poor prognosis, and most will succumb to their disease within 3–5 years of diagnosis. Therefore, it is important to examine not only treatments administered with a curative intent but also those given with a palliative intent.
At the present time, there is no evidence to support the use of radical radiation therapy alone, administered with curative intent, in the management of patients with MPM. The only randomized trials of radiation therapy for patients with
Conclusions
Based on the lack of evidence for the use of radical radiation therapy alone in the management of patients with MPM, radical radiation should not be offered as a curative treatment option to patients with MPM. Palliative radiation therapy may offer short-term symptom control; however, long-term control has not been demonstrated. This lack of evidence is particularly disappointing considering the poor prognosis of this disease and the need for therapies that can improve the survival and quality
Acknowledgements
The Program in Evidence-based Care is sponsored by, but editorially independent of, Cancer Care Ontario and the Ontario Ministry of Health and Long Term Care.
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Conflict of interest statement. The members of the Lung DSG disclosed potential conflicts of interest relating to the topic of this systematic review. The authors of this guideline declared that there were no conflicts of interest.
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See the Program in Evidence-based Care section of Cancer Care Ontario’s Web site (http://www.cancercare.on.ca/) for a list of current Disease Site Group members.