A randomised controlled trial of intervention site radiotherapy in malignant pleural mesothelioma

Drain site radiotherapy in malignant pleural mesothelioma: a wasted resource

“…We present a case which highlights the inadequacy of this practice and discuss the recent findings of O'ROURKE et al [1], which suggest irradiation should only be offered for symptomatic tumour nodules.…”

Multimodal management of malignant pleural mesothelioma: where are we today?

“…However, the precise dose and timing of radiotherapy remained unclear. Whether low-dose radiotherapy has to be delivered at incisional sites, including thoracoports, remains controversial, as conflicting results have been reported in recent literature [35][36][37][38][39]. A pooled analysis found no significant reduction in the frequency of procedure tract metastases [40].…”

Prevention of malignant seeding at drain sites after invasive procedures (surgery and/or thoracoscopy) by hypofractionated radiotherapy in patients with pleural mesothelioma

“…In the literature, the mean incidence is 19% ranging from 2 to 51% [7,10]. The original Boutin's trial reported a 40% seeding rate without radiation treatment whereas in both Bydder's and O'Rourke's trials this rate did not exceed 10% [7,11,12]; Cellerin et al reported an high incidence without radiotherapy (48%) in a retrospective series where the incidence of seeding in the treated arm was relatively high (21%) [15]. Moreover, literature data do not clearly show whether some procedures have higher risk in malignant seeding than others; anyway, the incidence of tract metastases may be lower with computed tomography-guided biopsies than with thoracoscopies, as suggested by some authors [10].…”

“…Dissonant responses come from two randomized trials: Bydder et al [11] and more recently O' Rourke et al [12] didn't find any benefit about prophylactic radiation therapy on drain sites in patients with malignant pleural mesothelioma. Anyway, it is remarkable that Bydder examined a single 10 Gy treatment with electrons of relative lower energy (9 MeV) that maybe suboptimal, whereas in the O' Rourke's trial the typical radiation field size (6 cm circle) was relatively small and 3/30 patients of the RT arm developed cutaneous seeding after subsequent invasive procedures not followed by a new prophylactic irradiation.…”

“…Bydder et al reported that no patients experienced Radiation Therapy Oncology Group (RTOG) or European Organization for Research and Treatment of Cancer (EORTC) grade 2Á4 toxicities following treatment [11]. O' Rourke et al observed 3/61 patients with persistent erithema/discolouration at radiotherapy site [12].…”