Intensity-modulated radiotherapy following extrapleural pneumonectomy for the treatment of malignant mesothelioma: clinical implementation

Forster, Kenneth; Smythe, W. Roy; Starkschall, George; Liao, Zhongxing; Takanaka, Tsuyoshi; Kelly, James; Vaporciyan, Ara A.; Ahamad, A.; Dong, Lei; Salehpour, Mohammad; Komaki, Ritsuko; Stevens, Craig W.

doi:10.1016/s0360-3016(02)04150-0

Cited by 103 publications

(52 citation statements)

References 17 publications

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“…Further attempts at improving local control with radiotherapy after EPP have focused on intensity modulated radiotherapy (IMRT), initially in the curative setting at MD Anderson [10,11] and in the palliative setting in Heidelberg [12]. See Table 1.…”

Section: Intensity Modulated Radiotherapymentioning

confidence: 99%

What Is the Role of Radiotherapy in Malignant Pleural Mesothelioma?

Price

2011

The Oncologist

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Objective. A review of the evidence supporting the use of radiotherapy in patients with mesothelioma was performed.Methods. Relevant publications were searched for on Medline.Results. In a Medline search on radiotherapy and mesothelioma, 611 hits were obtained. A limited number of prospective phase II trials of radiotherapy as part of trimodality protocols for early disease and in the palliation of pain were found, along with three small randomized controlled trials of port-site prophylaxis.Conclusion. No randomized data exist to support the use of radiotherapy after radical surgery, although there are a large number of publications describing its use as an integral part of therapy, including seven phase II studies. One ongoing trial is randomizing patients to radiotherapy or not after extrapleural pneumonectomy. None of these studies provided any assessment of radiotherapy independent of the other modalities investigated, nor did any formally assess intensity-modulated radiotherapy. There have been several reports of excessive toxicity with this technique, and its use should be limited to phase I studies until the basis of this toxicity is better understood. Three trials have looked at port-site prophylaxis, one supporting its use and two showing no evidence of benefit. Two studies addressed pain control prospectively, one showing definite but short-lived benefits.Implications. Radiotherapy is widely used in treating mesothelioma with little supporting evidence. More randomized trials are required to justify this use in all three common settings for its use. The Oncologist 2011; 16:359 -365

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Section: Intensity Modulated Radiotherapymentioning

confidence: 99%

What Is the Role of Radiotherapy in Malignant Pleural Mesothelioma?

Price

2011

The Oncologist

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“…After surgical resection, high-dose hemithoracic radiation therapy is a feasible treatment regimen and could improve local control [153]. Intensity-modulated radiotherapy might have even better results, because of its potential to conform doses more tightly to target volumes than conformal radiotherapy [154, 155]. …”

Section: Malignant Pleural Mesotheliomamentioning

confidence: 99%

Mesothelioma and Asbestos-Related Pleural Diseases

Greillier¹,

Astoul²

2008

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At present, the use of asbestos is not regulated at a worldwide scale. Moreover, there is a latency period between asbestos exposure and the manifestations of asbestos-related diseases. Consequently, pulmonologists are still dealing with consequences of asbestos exposure, which mainly occur at the pleural surface. The aim of this review is to provide an overview of asbestos-related pleural diseases. We summarized the most relevant data for the diagnosis and the management of benign asbestos pleural effusions, pleural plaques, diffuse pleural thickening and rounded atelectasis. Special attention is dedicated to malignant pleural mesothelioma, given the challenging issues of this disease, the recent advances in its management and the dynamism of research in this area.

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“…[1][2][3][4] However, lung-sparing pleurectomy-decortication (P/D) is increasingly a preferred surgical approach for MPM. 5,6 Safe delivery of cytotoxic radiation to the hemithorax with two intact radiosensitive lungs is challenging.…”

Section: Introductionmentioning

confidence: 99%

Phase II Study of Hemithoracic Intensity-Modulated Pleural Radiation Therapy (IMPRINT) As Part of Lung-Sparing Multimodality Therapy in Patients With Malignant Pleural Mesothelioma

Rimner

Zauderer

Gomez

et al. 2016

JCO

153

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We conducted a two-center phase II study to determine the safety of hemithoracic intensitymodulated pleural radiation therapy (IMPRINT) after chemotherapy and pleurectomy-decortication (P/D) as part of a multimodality lung-sparing treatment. Patients and MethodsPatients 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). ResultsA 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 followup, 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. ConclusionsHemithoracic 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.

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Intensity-modulated radiotherapy following extrapleural pneumonectomy for the treatment of malignant mesothelioma: clinical implementation

Cited by 103 publications

References 17 publications

What Is the Role of Radiotherapy in Malignant Pleural Mesothelioma?

What Is the Role of Radiotherapy in Malignant Pleural Mesothelioma?

Mesothelioma and Asbestos-Related Pleural Diseases

Phase II Study of Hemithoracic Intensity-Modulated Pleural Radiation Therapy (IMPRINT) As Part of Lung-Sparing Multimodality Therapy in Patients With Malignant Pleural Mesothelioma

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