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PET-guided dose escalation tomotherapy in malignant pleural mesothelioma

PET-geführte Dosiseskalationsstudie mit Tomotherapie bei malignen Pleuramesotheliomen

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Abstract

Purpose

To test the feasibility of salvage radiotherapy using PET-guided helical tomotherapy in patients with progressive malignant pleural mesothelioma (MPM).

Patients and Methods

A group of 12 consecutive MPM patients was treated with 56 Gy/25 fractions to the planning target volume (PTV); FDG-PET/CT simulation was always performed to include all positive lymph nodes and MPM infiltrations. Subsequently, a second group of 12 consecutive patients was treated with the same dose to the whole pleura adding a simultaneous integrated boost of 62.5 Gy to the FDG-PET/CT positive areas (BTV).

Results

Good dosimetric results were obtained in both groups. No grade 3 (RTOG/EORTC) acute or late toxicities were reported in the first group, while 3 cases of grade 3 late pneumonitis were registered in the second group: the duration of symptoms was 2–10 weeks. Median overall survival was 8 months (1.2–50.5 months) and 20 months (4.3–33.8 months) from the beginning of radiotherapy, for groups I and II, respectively (p = 0.19). A significant impact on local relapse from radiotherapy was seen (median time to local relapse: 8 vs 17 months; 1-year local relapse-free rate: 16% vs 81%, p = 0.003).

Conclusions

The results of this pilot study support the planning of a phase III study of combined sequential chemoradiotherapy with dose escalation to BTV in patients not able to undergo resection.

Zusammenfassung

Zweck

Prüfung der Machbarkeit von Salvage-Strahlentherapie mit der Hilfe PET-geführter helikaler Tomotherapie bei Patienten mit progredientem malignem Pleuramesotheliom (MPM).

Patienten und Methoden

Die erste Gruppe von 12 aufeinanderfolgenden MPM-Patienten wurde mit 56 Gy/25 Fraktionen im Planungszielvolumen behandelt. Eine FDG-PET/CT-Simulation wurde stets durchgeführt, um alle positiven Lymphknoten und MPM-Infiltrationen einzuschließen. Danach wurde eine zweite Gruppe von 12 aufeinanderfolgenden Patienten mit der gleichen Dosis auf der gesamten Pleura behandelt mit gleichzeitigem integriertem Boost von 62,5 Gy auf die FDG–PET/CT-positiven Bereiche (BTV).

Ergebnisse

Gute dosimetrische Ergebnisse wurden in beiden Gruppen erzielt. In der ersten Gruppe wurde keine akute oder späte Grad-3-Toxizität (RTOG / EORTC) berichtet, während drei Fälle von später Grad-3-Pneumonitis in der zweiten Gruppe auftraten. Die Symptome hielten 2 bis 10 Wochen an. Das mediane Gesamtüberleben betrug 8 Monate (1,2–50,5 Monate) und 20 Monate (4,3–33,8 Monate) ab Therapiebeginn in Gruppe I und II (p = 0,19). Es wurde signifikanter Einfluss der Strahlentherapie auf Lokalrezidive beobachtet (mediane Zeit bis zum Lokalrezidiv: 8 vs 17 Monate; Rate 1-jähriger Lokalrezidivfreiheit: 16% vs 81%, p = 0,003).

Schlussfolgerungen

Die Ergebnisse dieser Pilotstudie sprechen für die Planung einer Phase-III-Studie der kombinierten sequentiellen Radiochemotherapie mit Dosiseskalation auf BTV bei inoperablen Patienten.

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Authors and Affiliations

  1. Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy

    Andrei Fodor MD, Italo Dell’Oca, Marcella Pasetti & Nadia Gisella Di Muzio

  2. Medical Physics, San Raffaele Scientific Institute, Milan, Italy

    Claudio Fiorino, Sara Broggi, Giovanni Mauro Cattaneo & Riccardo Calandrino

  3. Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy

    Luigi Gianolli

  4. Department of Radiotherapy, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Andrei Fodor MD

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  1. Andrei Fodor MD
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  2. Claudio Fiorino
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  3. Italo Dell’Oca
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  4. Sara Broggi
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Correspondence to Andrei Fodor MD.

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Fodor, A., Fiorino, C., Dell’Oca, I. et al. PET-guided dose escalation tomotherapy in malignant pleural mesothelioma. Strahlenther Onkol 187, 736–743 (2011). https://doi.org/10.1007/s00066-011-2234-6

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  • DOI: https://doi.org/10.1007/s00066-011-2234-6

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