Chest
Volume 108, Issue 3, September 1995, Pages 754-758
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Clinical Investigations: Miscellaneous
Prevention of Malignant Seeding After Invasive Diagnostic Procedures in Patients With Pleural Mesothelioma: A Randomized Trial of Local Radiotherapy

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The purpose of this randomized prospective study was to assess the efficacy of local radiotherapy in preventing malignant seeding along invasive diagnostic procedures (cytology, needle biopsy, thoracoscopy, or chest tube placement) in patients with malignant pleural mesothelioma. Forty consecutive patients with histologically proven malignant mesothelioma were enrolled. Twenty patients received three daily sessions of radiotherapy at a dosage of 7 Gy 10 to 15 days after thoracoscopy. The other 20 patients did not receive radiotherapy. None of the 20 patients treated developed entry tract metastasis. In contrast, 8 of the 20 (40%) patients who were not treated developed metastases. These findings confirm the efficacy and safety of early local radiotherapy in preventing malignant seeding after invasive diagnostic procedures in patients with malignant pleural mesothelioma.

Section snippets

Patients

This study included 40 consecutive patients (33 men and 7 women; mean age, 66 ± 3 years) with pleural mesothelioma whose life expectancy was over 3 months at the time of diagnosis. All patients had undergone pleural cytologic study and Abrams needle biopsy within 1 month before thoracoscopy, and puncture sites were still clearly visible. Thirteen patients had positive cytologic findings (meaning detection of “malignant cells”) and 6 had positive needle biopsy results.

Thoracoscopy was performed

RESULTS

Patients were randomly divided into two groups of 20. In one group, radiotherapy was performed and in the other it was not. As shown in Table 1, there was no significant difference between these two groups with regard to clinical status, treatment, or median survival.

None of the patients in the treatment group developed subcutaneous nodules. Conversely, eight patients (40%) in the untreated group developed subcutaneous nodules (p<0.001) at entry sites of thoracoscopy trocars or chest tubes

DISCUSSION

This study confirms the efficacy and safety of local radiotherapy in preventing tract metastases after cytologic study, needle biopsy, thoracoscopy, or chest tube placement in patients with malignant mesothelioma.

This result contrasts sharply with the poor effectiveness of radiotherapy for pleural mesothelioma.23 Response rates have never exceeded 15%.24 In their series including 49 patients treated by radiation therapy, surgical resection, and chemotherapy, Mattson et al25 noted one complete

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