SYSTEMS-2: A randomised phase II study of radiotherapy dose escalation for pain control in malignant pleural mesothelioma

Ashton, Miranda; O’Rourke, N.; MacLeod, Nicholas; Laird, Barry; Stobo, Jon; Kelly, Caroline; Alexander, Laura E. Crotty; Franks, K.; Moore, Karen; Currie, S.; Valentine, R.; Chalmers, Anthony J.

doi:10.1016/j.ctro.2017.11.004

Cited by 18 publications

(11 citation statements)

References 14 publications

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“…In initial experiences, intensity modulated proton therapy (IMPT) has shown feasibility and lower mean doses to the contralateral lung, heart, esophagus, liver, and ipsilateral kidney compared with IMRT [ 17 , 28 , 29 , 30 ]. Dose escalation has not been shown to significantly reduce local failure after EPP [ 15 , 30 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Use of Continuous Positive Airway Pressure (CPAP) to Limit Diaphragm Motion—A Novel Approach for Definitive Radiation Therapy for Inoperable Pleural Mesothelioma: A Pilot Study

Moore

Kindler

Allen

2021

Biology

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Malignant pleural mesothelioma (MPM) is a deadly disease and radiotherapy (RT) plays an important role in its management. Recent developments in technique have made it is possible to deliver RT to MPM in the intact lung. However, it is imperative to reduce normal lung doses. We present a pilot study examining the use of CPAP and VMAT radiotherapy to reduce toxicity when treating MPM, involving three consecutive patients with MPM, not amenable to surgery, who were treated according to Helsinki committee approval. Patients were simulated using four-dimentional CT simulation with the assistance of CPAP lung inflation, then were treated using both IMRT and VMAT techniques. Radiation lung dose was optimized based on accepted lung dose constraints. Patients were followed for toxicity as well as local control and survival. Results: Three patients were treated with CPAP-based IMRT treatment. These patients tolerated the treatment and DVH constraints were able to be met. The comparison plans among the four VMAT arcs and the IMRT static field treatment were able to accomplish the treatment planning objectives without significant advantages with either technique. The treatment combined with CPAP reduced the normal lung dose in MPM patients with intact lungs. This technique is worthy of further investigation.

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Section: Discussionmentioning

confidence: 99%

Use of Continuous Positive Airway Pressure (CPAP) to Limit Diaphragm Motion—A Novel Approach for Definitive Radiation Therapy for Inoperable Pleural Mesothelioma: A Pilot Study

Moore

Kindler

Allen

2021

Biology

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“…The encouraging results of SYSTEMS-1 led the researchers to design a second trial, SYSTEMS-2[ 81 ], to compare the effects of an escalated dose (36 Gy in six fractions for 2 wk) and a standard dose (20 Gy in five fractions for 1 wk) delivered only to the tumor responsible for the pain (hemithoracic radiation was not contemplated). The planned sample size is 112 patients and patients will be treated with IMRT or, where not available, three-dimensional (3D) radiotherapy.…”

Section: Clinical Indications By Tumor Stage and Treatmentmentioning

confidence: 99%

GOECP/SEOR clinical guidelines on radiotherapy for malignant pleural mesothelioma

Luna¹,

Bobo²,

Cabrera-Rodríguez³

et al. 2021

WJCO

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Malignant pleural mesothelioma (MPM) is a rare tumor with poor prognosis and rising incidence. Palliative care is common in MPM as radical treatment with curative intent is often not possible due to metastasis or extensive locoregional involvement. Numerous therapeutic advances have been made in recent years, including the use of less aggressive surgical techniques associated with lower morbidity and mortality ( e.g. , pleurectomy/decortication), technological advancements in the field of radiotherapy (intensity-modulated radiotherapy, image-guided radiotherapy, stereotactic body radiotherapy, proton therapy), and developments in systemic therapies (chemotherapy and immunotherapy). These improvements have had as yet only a modest effect on local control and survival. Advances in the management of MPM and standardization of care are hampered by the evidence to date, limited by high heterogeneity among studies and small sample sizes. In this clinical guideline prepared by the oncological group for the study of lung cancer of the Spanish Society of Radiation Oncology, we review clinical, histologic, and therapeutic aspects of MPM, with a particular focus on all aspects relating to radiotherapy, including the current evidence base, associations with chemotherapy and surgery, treatment volumes and planning, technological advances, and reradiation.

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“…95 The authors concluded that RT for pain control in MPM is effective in some patients and plan to follow up their study with SYSTEMS-2, which will compare standard palliative RT dosing at 20 Gy in five daily fractions to an escalated dosing of 36 Gy in six daily fractions. 96…”

Section: Radiation Therapymentioning

confidence: 99%

Malignant Mesothelioma: Has Anything Changed?

Kim

Sterman

Haas

2019

Semin Respir Crit Care Med

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Malignant pleural mesothelioma is a rare cancer associated with asbestos exposure and portends a dismal prognosis. Its worldwide incidence has been increasing, and treatment options are currently suboptimal and noncurative. However, since the turn of the century, several encouraging steps have been made toward improving outcomes for mesothelioma patients. An increased understanding of disease pathophysiology has led to more accurate diagnosis and staging, and the establishment of the standard of care first-line pemetrexed/platin doublet chemotherapy regimen in 2003 initially revolutionized treatment. While significant debate remains regarding the preferred approach to surgical and radiation therapy in the context of multimodal therapy, recent breakthroughs in immunotherapy offer hope for another paradigm shift in the near future. This review will summarize the current clinical approach to diagnosis, staging, and treatment of malignant pleural mesothelioma.

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SYSTEMS-2: A randomised phase II study of radiotherapy dose escalation for pain control in malignant pleural mesothelioma

Cited by 18 publications

References 14 publications

Use of Continuous Positive Airway Pressure (CPAP) to Limit Diaphragm Motion—A Novel Approach for Definitive Radiation Therapy for Inoperable Pleural Mesothelioma: A Pilot Study

Use of Continuous Positive Airway Pressure (CPAP) to Limit Diaphragm Motion—A Novel Approach for Definitive Radiation Therapy for Inoperable Pleural Mesothelioma: A Pilot Study

GOECP/SEOR clinical guidelines on radiotherapy for malignant pleural mesothelioma

Malignant Mesothelioma: Has Anything Changed?

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