Pleural intensity-modulated radiotherapy for malignant pleural mesothelioma Journal Article
| Authors: | Rosenzweig, K. E.; Zauderer, M. G.; Laser, B.; Krug, L. M.; Yorke, E.; Sima, C. S.; Rimner, A.; Flores, R.; Rusch, V. |
| Article Title: | Pleural intensity-modulated radiotherapy for malignant pleural mesothelioma |
| Abstract: | Purpose: In patients with malignant pleural mesothelioma who are unable to undergo pneumonectomy, it is difficult to deliver tumoricidal radiation doses to the pleura without significant toxicity. We have implemented a technique of using intensity-modulated radiotherapy (IMRT) to treat these patients, and we report the feasibility and toxicity of this approach. Methods and Materials: Between 2005 and 2010, 36 patients with malignant pleural mesothelioma and two intact lungs (i.e., no previous pneumonectomy) were treated with pleural IMRT to the hemithorax (median dose, 46.8 Gy; range, 41.4-50.4) at Memorial Sloan-Kettering Cancer Center. Results: Of the 36 patients, 56% had right-sided tumors. The histologic type was epithelial in 78%, sarcomatoid in 6%, and mixed in 17%, and 6% had Stage I, 28% had Stage II, 33% had Stage III, and 33% had Stage IV. Thirty-two patients (89%) received induction chemotherapy (mostly cisplatin and pemetrexed); 56% underwent pleurectomy/decortication before IMRT and 44% did not undergo resection. Of the 36 patients evaluable for acute toxicity, 7 (20%) had Grade 3 or worse pneumonitis (including 1 death) and 2 had Grade 3 fatigue. In 30 patients assessable for late toxicity, 5 had continuing Grade 3 pneumonitis. For patients treated with surgery, the 1- and 2-year survival rate was 75% and 53%, and the median survival was 26 months. For patients who did not undergo surgical resection, the 1- and 2-year survival rate was 69% and 28%, and the median survival was 17 months. Conclusions: Treating the intact lung with pleural IMRT in patients with malignant pleural mesothelioma is a safe and feasible treatment option with an acceptable rate of pneumonitis. Additionally, the survival rates were encouraging in our retrospective series, particularly for the patients who underwent pleurectomy/decortication. We have initiated a Phase II trial of induction chemotherapy with pemetrexed and cisplatin with or without pleurectomy/ decortication, followed by pleural IMRT to prospectively evaluate the toxicity and survival. © 2012 Elsevier Inc. |
| Keywords: | adult; cancer chemotherapy; cancer survival; clinical article; human tissue; aged; aged, 80 and over; middle aged; cancer surgery; survival rate; treatment failure; fatigue; intensity modulated radiation therapy; cisplatin; cancer growth; treatment duration; treatment planning; antineoplastic agents; cancer radiotherapy; radiation dose; chemotherapy; cancer staging; follow up; neoplasm staging; cancer grading; multiple cycle treatment; esophagitis; nausea; vomiting; radiotherapy; oxygen; steroid; patient monitoring; histology; cancer mortality; dyspnea; pneumonia; disease severity; health status; imrt; intensity-modulated radiotherapy; physical therapy; tumors; feasibility studies; radiotherapy, intensity-modulated; guanine; patient safety; pleura mesothelioma; mesothelioma; surgery; surgical resection; dermatitis; platinum compounds; heart arrhythmia; lung function; toxicity; acute toxicity; forced expiratory volume; glutamates; phase ii; pemetrexed; decortication; pleurectomy; disease exacerbation; malignant pleural mesothelioma; pleural neoplasms; median survival; induction chemotherapy; pericarditis; artificial ventilation; pneumonitis; thorax; radiation pneumonitis; cis-platin; malignant pleural mesotheliomas |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 83 |
| Issue: | 4 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2012-07-15 |
| Start Page: | 1278 |
| End Page: | 1283 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2011.09.027 |
| PUBMED: | 22607910 |
| PROVIDER: | scopus |
| PMCID: | PMC4359620 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 3" - "Export Date: 9 January 2013" - "CODEN: IOBPD" - "Source: Scopus" |
Altmetric
Citation Impact
BMJ Impact Analytics
Related MSK Work