External beam radiation therapy for the treatment of pleural mesothelioma
Section snippets
Radical treatment
Maasilta [2] described a group of 34 patients with unresected mesothelioma who received treatment for the entire hemithorax with three different high-dose RT regimens. There was no attempt to shield the intact lung; the spinal cord was shielded from the posterior field after 40 Gy; and the liver was partially shielded from the anterior and posterior fields after 30 Gy. The dose regimens were (1) 55 Gy to the hemithorax in 2.2-Gy fractions (split course) followed by a 15-Gy boost to macroscopic
Radiation therapy as adjuvant treatment for pleural mesothelioma after pleurectomy: treatment of microscopic disease with an intact lung
The delivery of radical radiotherapy to the hemithorax after pleurectomy presents similar technical challenges as discussed previously because the sensitive normal lung is still in place. Kutcher et al [9] described a technique that uses a combination of photons and electrons to deliver a dose of 42.5 Gy ± 10% to most of the pleura. The treatment involves anterior and posterior photon fields to cover the entire hemithorax with blocks to protect the lung, liver, and stomach. The blocked areas
Radiation therapy as adjuvant treatment for pleural mesothelioma after extrapleural pneumonectomy: treatment of microscopic disease with an absent lung
As a consequence of the high rate of local recurrence after pleurectomy with or without adjuvant treatment, several investigators have pursued more aggressive local treatment with EPP [13], [14], [15], [16]. This surgery has been well described and involves en bloc resection of the lung, entire pleura, ipsilateral diaphragm, and ipsilateral pericardium [13]. Several groups have enhanced their treatment with the addition of postoperative RT with or without chemotherapy. There are two major
Summary
Technical challenges in the treatment of pleural mesothelioma with radiotherapy remain. When there is limited or no resection of disease, delivery of high-dose RT to the entire hemithorax in the setting of an intact lung has not been shown to be associated with any survival benefit, and the toxicity is clearly significant. Conversely, the use of palliative RT delivered to limited fields (less than hemithorax) can provide pain relief in 50% to 70% of cases. After pleurectomy and decortication,
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Cited by (42)
European guidelines for the management of malignant pleural mesothelioma
2011, Journal of Advanced ResearchCitation Excerpt :Although the removal of the ipsilateral lung during EPP eliminates the lung from the radiation treatment field, the complex target volume of the post-operative hemithorax remains a serious challenge for PORT. Phase II trials including PORT after EPP showed varying results with vast differences in local and systemic recurrences, most likely reflecting different radiation techniques and the dosages administered [44,45]. No phase III randomized trials of PORT post-EPP exist, but a randomized multicenter European study is ongoing (SAKK study).
Pleural Masses
2010, Medical Management of the Thoracic Surgery PatientPleural Masses
2009, Medical Management of the Thoracic Surgery PatientLocal recurrence of tumor at sites of intervention in malignant pleural mesothelioma
2008, Lung CancerCitation Excerpt :In a randomized study, it has been shown that LD developed in 40% of patients who did not receive PR, whereas progression of LD was not observed in patients who received PR [2]. Local PR is commonly applied to MPM patients: this process is presented as group A evidence [2,4–6]. In recent years, multi-modal treatment and chemotherapy have been more commonly used to treat MPM patients [7].
Relapse pattern and second-line treatment following multimodality treatment for malignant pleural mesothelioma
2016, European Journal of Cardio-thoracic Surgery