Radical Radiation Therapy After Lung-Sparing Surgery for Malignant Pleural Mesothelioma: Survival, Pattern of Failure, and Prognostic Factors

Minatel, Emilio; Trovò, Marco; Bearz, Alessandra; Maso, Matteo Di; Baresic, Tanja; Drigo, A.; Barresi, L.; Furlan, Carlo; Conte, Alessandro Del; Bruschi, Gioia; Fontana, Paolo; Pagan, V.; Franchin, Giovanni

doi:10.1016/j.ijrobp.2015.06.029

Cited by 44 publications

(22 citation statements)

References 14 publications

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“…The assumption of the technique used at our institution was that loss of ventilation in the irradiated lung could be largely compensated by the functioning contralateral lung, but the other toxicities outweighed the potential benefits of this treatment. There are other series using IMRT and tomotherapy that have reported lower rates of toxicities than what we have found, however, most are single institution retrospective studies with fewer patients than our series . The higher incidence of severe toxicity in our IMRT patients (78%), compared to other series and to our 3D‐CRT patients (53%), may be due to the larger target volumes and higher doses used for the IMRT group.…”

Section: Discussioncontrasting

confidence: 58%

High‐dose palliative radiotherapy for malignant pleural mesothelioma

Foroudi

Smith²,

Putt

et al. 2017

J Med Imag Rad Onc

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Introduction: High-dose radiotherapy to the hemithorax for patients with malignant pleural mesothelioma is a controversial treatment. Between 2003 and 2013 our institution had a policy of giving hemithoracic radiotherapy to at least 45 Gy. This retrospective study reports survival, progression and toxicity associated with this policy. Methods: Seventy-one patients with pleural mesothelioma were irradiated with doses of 45-60 Gy. Conformal radiotherapy (3D-CRT) to the lower hemithorax was used for 17 and intensity-modulated radiotherapy (IMRT) to the whole hemithorax for 54 patients. All patients have been followed up for at least 2 years from commencement of radiotherapy. Results: Sixty-four patients (90%) completed planned radiotherapy and seven stopped early, usually due to progressive disease. Median overall survival was 9.5 months (95% CI: 7.7-12.4) and median progression-free survival was 4.9 months (95% CI: 4.4-5.8). Eighty-seven per cent of patients progressed or died within 2 years: 25% in-field, 49% outside the RT field and 13% died without progression. Severe toxicity (grade 3-5) was observed in 53% of 3D-CRT and 78% of IMRT patients, most commonly pulmonary fibrosis 27%, radiation dermatitis 18%, dyspnoea 11%, GGT increased 11%, pneumonitis 10%, pleuritic pain 8% and fatigue 8%. There were two, possibly three, treatmentrelated deaths. Conclusion: High-dose radiotherapy to the hemithorax caused significant toxicity to most patients with no improvement in survival. Lower doses of radiotherapy to limited volumes may be useful for palliative purposes.

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Section: Discussioncontrasting

confidence: 58%

High‐dose palliative radiotherapy for malignant pleural mesothelioma

Foroudi

Smith²,

Putt

et al. 2017

J Med Imag Rad Onc

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“…Minatel et al performed extended P/D in 35 of 69 patients with malignant pleural mesothelioma and partial pleurectomy in the remaining 34 patients. After implementing postoperative IMRT (50 Gy/25 fr) with a simultaneous boost of 60 Gy in 25 fractions (2.4 Gy per fraction) for residual disease, favorable 2-year survival rates of 65 and 58%, respectively, were achieved in the two groups (13). They also reported that complications from IMRT did not cause treatment interruptions in any of the patients; the scheduled irradiation was completed in all patients, and complications were generally within a tolerable range (13).…”

Section: Discussionmentioning

confidence: 98%

Double cancer comprising malignant pleural mesothelioma and squamous cell carcinoma of the lung treated with radiotherapy: A case report

et al. 2018

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Pleurectomy/decortication (P/D) is the surgical treatment of choice for early malignant mesothelioma, but it remains unclear whether radiotherapy along with P/D should be used as multimodal treatment for this disease. We herein present the case of a 76-year-old man with a history of asbestos exposure who was diagnosed with left-sided malignant pleural mesothelioma in February 2010. The patient underwent chemotherapy with a combination of cisplatin and pemetrexed and achieved stable disease, after which time he was kept under observation. A positron emission tomography/computed tomography scan performed in February 2011 revealed nodular shadows with fluorodeoxyglucose uptake in S3 of the left lung; using bronchoscopy, the patient was diagnosed with stage IIB (cT3N0M0) primary squamous cell carcinoma. Chemoradiotherapy with vinorelbine and 60 Gy/20 fr radiotherapy was performed, and a partial response was obtained, suggesting that the radiotherapy used to treat the carcinoma of the lung may have also helped control the disease activity of the pre-existing mesothelioma. The present case indicates the value of radiotherapy in the treatment of malignant mesothelioma. The aim of the present study was to examine the possibility of new multimodal treatments for mesothelioma, along with a discussion of the relevant literature.

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“…The use of EPP in the trimodality management of MPM is now associated with decreased operative mortality and increased RFS when compared with other surgeries with a 3‐year survival rate of 30% . Alternative lung sparing surgical approaches have gained interest as a part of multimodality therapy for MPM . At a median follow‐up of 12.2 months, Chance et al.…”

Section: Discussionmentioning

confidence: 99%