Phase II study of hemithoracic intensity-modulated pleural radiation therapy (IMPRINT) as part of lung-sparing multimodality therapy in patients with malignant pleural mesothelioma Journal Article


Authors: Rimner, A.; Zauderer, M. G.; Gomez, D. R.; Adusumilli, P. S.; Parhar, P. K.; Wu, A. J.; Woo, K. M.; Shen, R.; Ginsberg, M. S.; Yorke, E. D.; Rice, D. C.; Tsao, A. S.; Rosenzweig, K. E.; Rusch, V. W.; Krug, L. M.
Article Title: Phase II study of hemithoracic intensity-modulated pleural radiation therapy (IMPRINT) as part of lung-sparing multimodality therapy in patients with malignant pleural mesothelioma
Abstract: Purpose: We conducted a two-center phase II study to determine the safety of hemithoracic intensity-modulated pleural radiation therapy (IMPRINT) after chemotherapy and pleurectomy-decortication (P/D) as part of a multimodality lung-sparing treatment. Patients and Methods: Patients received up to four cycles of pemetrexed plus platinum. If feasible, P/D was performed. Hemithoracic IMPRINT was administered to a planned dose of 50.4 Gy in 28 fractions. The primary end point was the incidence of grade 3 or greater radiation pneumonitis (RP). Results: A total of 45 patients were enrolled; 18 were not evaluable (because of disease progression before radiation therapy [RT], n = 9; refusal of surgery or RT, n = 5; extrapleural pneumonectomy at time of surgery, n = 2; or chemotherapy complications, n = 2). A total of 26 patients received pemetrexed plus cisplatin, 18 received pemetrexed plus carboplatin, and four received a combination. Thirteen patients (28.9%) had a partial response, 15 patients (33.3%) experienced disease progression, one patient died during chemotherapy, and all others had stable disease. Eight patients underwent P/D or an extended P/D, and 13 underwent a partial P/D. A total of 27 patients started IMPRINT (median dose, 46.8 Gy; range, 28.8 to 50.4 Gy) and were evaluable for the primary end point (median follow-up, 21.6 months). Six patients experienced grade 2 RP, and two patients experienced grade 3 RP; all recovered after corticosteroid initiation. No grade 4 or 5 radiation-related toxicities were observed. The median progression-free survival and overall survival (OS) were 12.4 and 23.7 months, respectively; the 2-year OS was 59% in patients with resectable tumors and was 25% in patients with unresectable tumors. Conclusions: Hemithoracic IMPRINT for malignant pleural mesothelioma (MPM) is safe and has an acceptable rate of RP. Its incorporation with chemotherapy and P/D forms a new lung-sparing treatment paradigm for patients with locally advanced MPM. © 2016 by American Society of Clinical Oncology.
Journal Title: Journal of Clinical Oncology
Volume: 34
Issue: 23
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2016-08-10
Start Page: 2761
End Page: 2768
Language: English
DOI: 10.1200/jco.2016.67.2675
PROVIDER: scopus
PUBMED: 27325859
PMCID: PMC5019761
DOI/URL:
Notes: Article -- Export Date: 1 September 2016 -- Source: Scopus
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MSK Authors
  1. Preeti Kanwal Parhar
    13 Parhar
  2. Valerie W Rusch
    640 Rusch
  3. Michelle S Ginsberg
    155 Ginsberg
  4. Lee M Krug
    204 Krug
  5. Ronglai Shen
    126 Shen
  6. Andreas Rimner
    253 Rimner
  7. Abraham Jing-Ching Wu
    198 Wu
  8. Ellen D Yorke
    314 Yorke
  9. Kaitlin Marie Woo
    97 Woo