Failure patterns after hemithoracic pleural intensity modulated radiation therapy for malignant pleural mesothelioma Journal Article


Authors: Rimner, A.; Spratt, D. E.; Zauderer, M. G.; Rosenzweig, K. E.; Wu, A. J.; Foster, A.; Yorke, E. D.; Adusumilli, P.; Rusch, V. W.; Krug, L. M.
Article Title: Failure patterns after hemithoracic pleural intensity modulated radiation therapy for malignant pleural mesothelioma
Abstract: Purpose: We previously reported our technique for delivering intensity modulated radiation therapy (IMRT) to the entire pleura while attempting to spare the lung in patients with malignant pleural mesothelioma (MPM). Herein, we report a detailed pattern-of-failure analysis in patients with MPM who were unresectable or underwent pleurectomy/decortication (P/D), uniformly treated with hemithoracic pleural IMRT. Methods and Materials: Sixty-seven patients with MPM were treated with definitive or adjuvant hemithoracic pleural IMRT between November 2004 and May 2013. Pretreatment imaging, treatment plans, and posttreatment imaging were retrospectively reviewed to determine failure location(s). Failures were categorized as in-field (within the 90% isodose line), marginal (<90% and ≥50% isodose lines), out-of-field (outside the 50% isodose line), or distant. Results: The median follow-up was 24 months from diagnosis and the median time to in-field local failure from the end of RT was 10 months. Forty-three in-field local failures (64%) were found with a 1- and 2-year actuarial failure rate of 56% and 74%, respectively. For patients who underwent P/D versus those who received a partial pleurectomy or were deemed unresectable, the median time to in-field local failure was 14 months versus 6 months, respectively, with 1- and 2-year actuarial in-field local failure rates of 43% and 60% versus 66% and 83%, respectively (P=.03). There were 13 marginal failures (19%). Five of the marginal failures (38%) were located within the costomediastinal recess. Marginal failures decreased with increasing institutional experience (P=.04). Twenty-five patients (37%) had out-of-field failures. Distant failures occurred in 32 patients (48%). Conclusions: After hemithoracic pleural IMRT, local failure remains the dominant form of failure pattern. Patients treated with adjuvant hemithoracic pleural IMRT after P/D experience a significantly longer time to local and distant failure than patients treated with definitive pleural IMRT. Increasing experience and improvement in target delineation minimize the incidence of avoidable marginal failures.
Keywords: adult; aged; cancer surgery; treatment failure; major clinical study; intensity modulated radiation therapy; cisplatin; multimodality cancer therapy; treatment planning; conference paper; adjuvant therapy; cancer adjuvant therapy; cancer patient; cancer radiotherapy; follow up; medical record review; retrospective study; experience; pleura mesothelioma; pemetrexed; decortication; pleurectomy; pleura; linear accelerator; thorax; partial body radiation; malignant pleural mesotheliomas; human; male; female; failure patterns
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 90
Issue: 2
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2014-10-01
Start Page: 394
End Page: 401
Language: English
DOI: 10.1016/j.ijrobp.2014.05.032
PROVIDER: scopus
PUBMED: 25073664
PMCID: PMC5560169
DOI/URL:
Notes: Export Date: 1 December 2014 -- Source: Scopus
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MSK Authors
  1. Valerie W Rusch
    638 Rusch
  2. Lee M Krug
    202 Krug
  3. Andreas Rimner
    253 Rimner
  4. Abraham Jing-Ching Wu
    198 Wu
  5. Ellen D Yorke
    314 Yorke
  6. Daniel Eidelberg Spratt
    83 Spratt
  7. Amanda Foster
    62 Foster