Tomotherapy Improves Local Control and Changes Failure Patterns in Locally Advanced Malignant Pleural Mesothelioma

Kishan, Amar U.; Cameron, Robert B.; Wang, J.; Alexander, Stephon; Qi, Xiaomei; Kupelian, P.; Steinberg, Michael L.; Lee, J.M.; Selch, Michael T.; Lee, P.

doi:10.1016/j.ijrobp.2015.07.1560

Cited by 2 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

“…Several studies have shown improved toxicity profiles and local control with IMRT after pleurectomy/decortication . In addition, helical tomotherapy, a form of IMRT that uses a rotational gantry system, has also shown promise in the adjuvant treatment of pleural mesothelioma in terms of improved local control with acceptable toxicity reported …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

High‐dose palliative radiotherapy for malignant pleural mesothelioma

Foroudi

Smith²,

Putt

et al. 2017

J Med Imag Rad Onc

View full text Add to dashboard Cite

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.

show abstract

Section: Discussioncontrasting

confidence: 58%

Section: Introductionmentioning

confidence: 99%

High‐dose palliative radiotherapy for malignant pleural mesothelioma

Foroudi

Smith²,

Putt

et al. 2017

J Med Imag Rad Onc

View full text Add to dashboard Cite

show abstract

“…Rimner et al further compared the post-P/D HT with 3-dimensional conformal RT (3D-CRT) plans and demonstrated that the target coverage was notably improved with HT plans, which further translated into significantly improved local recurrence-free survival durations (19.0 versus 10.9 months; p < 0.05) [17]. Kishan et al investigated the feasibility of intensity-modulated proton therapy (IMPT) in MPM patients with both lung intact and noted that IMPT was efficient in reducing the mean RT doses to the uninvolved lung, heart, esophagus, liver, and ipsilateral kidney [18]. Moreover, the researchers also reported superior sparing of the uninvolved lung even when further mediastinal boost doses were required for node-positive disease status.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric Comparison of Lung-Sparing Radiation Therapy between Volumetric Arc Therapy and Helical Tomotherapy for Unresectable Malignant Pleural Mesothelioma

Pehlivan

Sengul

Yeşil

et al. 2019

BioMed Research International

View full text Add to dashboard Cite

Objective. To compare volumetric arc therapy (VMAT) and helical tomotherapy (HT) plans in terms of dosimetric parameters in positron emission tomography- (PET-) computerized tomography- (CT-) based radiation therapy planning in unresectable malignant pleural mesothelioma (MPM). Methods. CT and coregistered PET-CT data from seven patients with histologically-proven MPM were utilized for VMAT and HT plans. Target volumes and organs at risk (OARs) were delineated. The prescription doses for planning target volume 1 (PTV1) and PTV2 were 45.0 Gy and 54 Gy in 1.8 Gy/fr, respectively. Each technique was evaluated in terms of target volume coverage and OAR doses. Findings. Although the maximum (p=0.001) and mean (p<0.001) doses of PTV1, and PTV2 (p<0.001 for maximum and p=0.001 for mean doses) favored the HT technique over VMAT, both techniques efficiently covered the target volumes. Additionally, HT also provided more homogeneous dose distribution (p<0.001) and numerically lower doses received by most OARs, but again both rotational techniques were successful in keeping the OAR doses below the universally accepted limits. The major disadvantage of the HT technique was the requirement for longer treatment times (7.4 versus 2.5 minutes/fr; p<0.001) to accomplish the intended treatment. Conclusion. Results of this dosimetric comparison clearly demonstrated the possibility of safe hemithoracic irradiation of medically/technically unresectable MPM patients with either of the two rotational RT techniques, namely the VMAT and HT. Clinically, considering their poor prognosis, these promising findings may open a potential new window for curative treatment of unresectable MPM patients, if further confirmed by future clinical studies.

show abstract

Tomotherapy Improves Local Control and Changes Failure Patterns in Locally Advanced Malignant Pleural Mesothelioma

Cited by 2 publications

References 0 publications

High‐dose palliative radiotherapy for malignant pleural mesothelioma

High‐dose palliative radiotherapy for malignant pleural mesothelioma

Dosimetric Comparison of Lung-Sparing Radiation Therapy between Volumetric Arc Therapy and Helical Tomotherapy for Unresectable Malignant Pleural Mesothelioma

Contact Info

Product

Resources

About