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Impact of intensity-modulated radiation therapy on outcomes for malignant pleural mesothelioma treated with trimodality therapy

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

This study aims to report on patients (pts) with potentially resectable pleural mesothelioma treated with induction chemotherapy (CT) followed by extrapleural pneumonectomy (EPP) and adjuvant intensity-modulated radiation therapy (IMRT).

Methods

From 2002 to 2008 a retrospective review found 16 consecutive mesothelioma pts planned for trimodality care. CT involved a platinum-based doublet. EPP was carried out after pt restaging. IMRT to a dose of 54 Gy was given at least 4 weeks after EPP. Study endpoints included toxicity, dosimetric parameters, time to recurrence, and survival.

Results

Two pts progressed during CT and did not undergo EPP. One pt died after surgery. Thirteen pts (81 %) completed all treatments. Concerning IMRT, the mean of mean lung doses (MLDs) was 9.28 Gy. The mean percent of lung volume receiving 5 Gy (V5) and 20 Gy (V20) was 81.3 and 5.0 %, respectively. Acute radiation pulmonary toxicities included two grade 3 events. V30 was significantly associated with ≥grade 2 pulmonary toxicity (p = 0.041). There were no pulmonary-related deaths. Mean follow-up from CT start for 16 pts was 17.7 months (range, 1.3 to 66.3). Median survival (MS) was 20.2 months for pts completing therapy. Actuarial overall survival at 3 years was 31.6 %. Pathologic nodal stage did not correlate with overall or recurrence-free survival. Median time to local and/or distant recurrence from CT start was 15.3 months for pts completing therapy. All pts with local and regional failures also had distant failure. Two pts failed distantly only.

Conclusion

IMRT resulted in minimal pulmonary toxicity. Local control and survival remain challenging despite trimodality care.

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Conflict of interest

Dr. Adelstein has obtained grant funding for research purposes from the following companies: AstraZeneca, Sonafi-Aventis, Inc., and GlaxoSmithKline. On behalf of all other authors, the corresponding author reports that there is no conflict of interest to disclose.

Ethical standards

IRB approval was obtained for this retrospective review. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

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Correspondence to Erin S. Murphy.

Additional information

This work was presented in part at the 2009 ASTRO meeting.

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Murphy, E.S., Adelstein, D.J., Murthy, S.C. et al. Impact of intensity-modulated radiation therapy on outcomes for malignant pleural mesothelioma treated with trimodality therapy. J Radiat Oncol 3, 159–166 (2014). https://doi.org/10.1007/s13566-014-0142-y

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  • DOI: https://doi.org/10.1007/s13566-014-0142-y

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