The SYSTEMS Study
Is radiotherapy useful for treating pain in mesothelioma? Recipient of JHMRF’s Brother Peter Fellowship, Nicholas-MacLeod, conducted a multi centre study to find out.
Patients with mesothelioma may suffer from pain, which in some cases can be severe and difficult to treat with painkilling drugs. Radiotherapy has been given for a number of years to attempt to relieve pain but there is very little evidence to support this use. In addition, giving radiotherapy in this situation is complicated by the fact that mesothelioma affects the lining of the entire lung. If radiotherapy is given to the entire lung, this can be associated with side effects that may negate any potential gains in terms of pain control.
The SYSTEMS study was a multi centre study performed in the UK in which patients with mesothelioma received a standard dose of radiotherapy over 5 days to the area of pain. The patients were followed up for 12 weeks and the number of patients who responded to radiotherapy was recorded. The study was open to recruitment between June 2012 and December 2013. In total, 40 patients were recruited between cancer centres in Glasgow, Edinburgh and Sheffield. 14 patients had improvement in their pain 5 weeks after the radiotherapy, with 5 patients having a complete resolution of their pain. No changes in other factors such as breathlessness and quality of life were detected in the duration of the study but this could be explained by the relatively small number of participants.
The improvement seen in pain control in this study is encouraging. The SYSTEMS study was the largest study ever to look at radiotherapy for pain control in mesothelioma. The study would not have been possible without the support of the JHMRF and I cannot thank the charity enough for awarding me the Brother Peter Fellowship which enabled me to carry out this work. The main results from the study were recently published in the Journal of Thoracic Oncology.
Given the positive results achieved in the SYSTEMS study, further funding has been obtained from the JHMRF. A research fellow is in the process of being appointed to run the follow-on SYSTEMS 2 study. This study will be a randomised controlled trial where patients with mesothelioma related pain will receive either standard dose radiotherapy or a higher dose of radiotherapy to see if a higher dose can bring about an improvement in pain control. This study is due to open to recruitment within the next few months and should be open in many centres throughout the UK. It will be the first study of its kind in mesothelioma and will hopefully give further insight into the optimal management of pain in mesothelioma