A phase II trial of surgical resection and adjuvant highdose hemithoracic radiation for malignant pleural mesothelioma Journal Article
| Authors: | Rusch, V. W.; Rosenzweig, K.; Venkatraman, E.; Leon, L.; Raben, A.; Harrison, L.; Bains, M. S.; Downey, R. J.; Ginsberg, R. J. |
| Article Title: | A phase II trial of surgical resection and adjuvant highdose hemithoracic radiation for malignant pleural mesothelioma |
| Abstract: | Background: Surgical resection of malignant pleural mesothelioma is reported to have up to an 80% rate of local recurrence. We performed a phase II trial of highdose hemithoracic radiation after complete resection to determine feasibility and to estimate rates of local recurrence and survival. Methods: Patients were eligible if they had a resectable tumor, as determined by computed tomographic scanning, and adequate cardiopulmonary function for extrapleural pneumonectomy or pleurectomy/decortication. After complete resection, patients received hemithoracic radiation (54 Gy) and then were followed up with serial computed tomographic scanning. Results: From 1995 to 1998, 88 patients (73 men and 15 women; median age, 62.5 years) were entered into the study. The operations performed included 62 extrapleural pneumonectomies (70%) and 5 pleurectomies/decortications; procedures for exploration only were performed in 21 patients. Seven (7.9%) patients died postoperatively. Adjuvant radiation administered to 57 patients (54 undergoing extrapleural pneumonectomy and 3 undergoing pleurectomy/decortication) at a median dose of 54 Gy was well tolerated (grade 0-2 fatigue, esophagitis), except for one late esophageal fistula. The median survival was 33.8 months for stage I and II tumors but only 10 months for stage III and IV tumors (P = .04). For the patients undergoing extrapleural pneumonectomy, the sites of recurrence were locoregional in 2, locoregional and distant in 5, and distant only in 30. Conclusion: Hemithoracic radiation after complete surgical resection at a dose not previously reported is feasible. This approach dramatically reduces local recurrence and is associated with prolonged survival for early-stage tumors. Stage III disease has a high risk of early distant relapse and should be considered for trials of systemic therapy added to this regimen of resection and radiation. |
| Keywords: | adult; cancer survival; controlled study; treatment outcome; aged; middle aged; cancer surgery; survival rate; major clinical study; clinical trial; cancer recurrence; treatment planning; cancer radiotherapy; radiation dose; radiotherapy, adjuvant; cancer staging; prospective studies; computer assisted tomography; controlled clinical trial; phase 2 clinical trial; lung resection; feasibility studies; surgical risk; clinical protocols; malignant mesothelioma; pleura mesothelioma; mesothelioma; pleurectomy; pleural neoplasms; heart function; hemibody irradiation; humans; human; male; female; priority journal; article |
| Journal Title: | Journal of Thoracic and Cardiovascular Surgery |
| Volume: | 122 |
| Issue: | 4 |
| ISSN: | 0022-5223 |
| Publisher: | Mosby Elsevier |
| Date Published: | 2001-10-01 |
| Start Page: | 788 |
| End Page: | 795 |
| Language: | English |
| DOI: | 10.1067/mtc.2001.116560 |
| PUBMED: | 11581615 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Export Date: 21 May 2015 -- Source: Scopus |
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