Adjuvant radiotherapy after extrapleural pneumonectomy for mesothelioma. Prospective analysis of a multi-institutional series

Tonoli, Sandro; Vitali, Paola; Scotti, Vieri; Bertoni, F.; Spiazzi, L.; Ghedi, B.; Buonamici, F. Banci; Marrazzo, L.; Guidi, G.; Meattini, Icro; Bastiani, P.; Amichetti, Maurizio; Schwarz, Marco; Magrini, Stefano Maria

doi:10.1016/j.radonc.2011.09.025

Cited by 42 publications

(29 citation statements)

References 16 publications

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“…While 2D combined photon/electron conventional RT had historically been the standard technique available at the time, the development of intensity-modulated pleural radiation therapy (IMPRINT) in the past decade has made a more precise application of hemithoracic RT possible, reducing areas of dose uncertainty and doses to underlying organs at risk, in particular the lungs, but also the heart, liver, stomach, kidneys and bowels. 9-18 …”

Section: Introductionmentioning

confidence: 99%

Improved Outcomes with Modern Lung-Sparing Trimodality Therapy in Patients with Malignant Pleural Mesothelioma

Shaikh

Zauderer

Reibnitz

et al. 2017

Journal of Thoracic Oncology

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Introduction Higher target conformity and better sparing of organs at risk with modern radiotherapy (RT) may result in higher tumor control and less toxicities. In this study, we compare our institutional multimodality therapy experience of adjuvant chemotherapy and hemithoracic intensity-modulated pleural RT (IMPRINT) to previously used adjuvant conventional RT (CONV) in patients with malignant pleural mesothelioma (MPM) treated with lung-sparing pleurectomy/decortication (P/D). Methods We analyzed 209 patients who underwent P/D and adjuvant RT (n[CONV]=131, n[IMPRINT]=78) for MPM between 1974 and 2015. The primary endpoint was overall survival (OS). The Kaplan-Meier method and Cox proportional hazards model were used to calculate OS; competing ri sks analysis was performed for local failure-free (LFFS) and progression-free survival (PFS). Univariate (UVA) and multivariate analysis (MVA) was performed with relevant clinical and treatment factors. Results The median age was 64 years, 80% were male. Patients receiving IMPRINT had significantly higher rates of epithelial histology, advanced pStage and chemotherapy treatment. OS was significantly higher after IMPRINT (median 20.2 vs 12.3 months, p=0.001). Higher Karnofsky performance score (KPS), epithelioid histology, macroscopically complete resection (MCR), and use of chemotherapy/IMPRINT were found to be significant factors for longer OS upon MVA. No significant predictive factors were identified for local failure or progression. Fewer patients developed grade ≥2 esophagitis after IMPRINT compared to CONV (23% vs 47%). Conclusions Trimodality therapy including adjuvant hemithoracic IMPRINT, chemotherapy, and P/D is associated with promising OS rates and decreased toxicities in patients with MPM. Dose constraints should be applied vigilantly to minimize serious adverse events.

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Section: Introductionmentioning

confidence: 99%

Improved Outcomes with Modern Lung-Sparing Trimodality Therapy in Patients with Malignant Pleural Mesothelioma

Shaikh

Zauderer

Reibnitz

et al. 2017

Journal of Thoracic Oncology

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“…IMRT technique can reduce dose to OARs, with a small and clinically negligible increase in dose absorption to the contralateral lung, compared with conventional 3D-CRT technique. To date, the role of IMRT in the treatment of MPM is not supported by clear evidence, and its use is limited inside an experimental series [4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…The majority of trials regarding the use of radiotherapy as a component of radical treatment, both in a trimodality approach and as an adjuvant therapy after EPP, showed with IMRT a reduced dose to OARs such liver, hearth, kidney and affected lung, but an increased dose to contralateral lung and kidney [4][5][6][7][8]. Moreover, some authors reported serious adverse events, like the Boston experience, where six of 13 patients treated with IMRT after EPP (dose 5400 cGy, with a V20 >20%) died from radiation pneumonitis [10].…”

Section: Discussionmentioning

confidence: 99%

“…Surgery is considered the treatment of choice, by means of an extrapleural pneumonectomy (EPP) or pleurectomy/decortication, but the rate of local control is very low in local advanced disease and, consequently, a local radical therapy is often needed in order to prolong the time to progression [1,2]. In this setting, 3D conventional external beam radiotherapy encounters great difficulties, due to the large radiation fields required, resulting in increased risk of lung toxicity [3,4].…”

Section: Introductionmentioning

confidence: 99%

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Intensity-Modulated Radiotherapy for Relapsed Malignant Pleural Mesothelioma

et al. 2016

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The use of novel radiotherapy techniques is widely increasing, allowing clinicians to treat diseases that were previously difficult to treat with radiation therapy. Malignant pleural mesothelioma is a clear example of this clinical challenge. We describe our first experience with intensity-modulated radiotherapy technique which was used to treat a 73-year-old patient with multiple relapsing malignant pleural mesothelioma. Intensity-modulated radiation therapy has allowed to respect the QUANTEC (quantitative analyses of normal tissue effects in the clinic) dose constraints, patient has experienced a 14 months progression-free time, without relevant subacute or late lung toxicity.

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“…After neo-adjuvant chemotherapy with cisplatin-pemetrexed, they underwent surgery (extrapleural pneumonectomy, pericardiectomy, and emidiaphagmectomy with reconstruction of the pericardium and emidiaphragm with prosthetic material (e.g., Goretex) or bovine pericardium, and ipsilateral mediastinal lymphadenectomy), followed by adjuvant emithorax irradiation via staticfield IMRT on a 6 MV Linac. A total of 45 patients were treated with this approach from 2005-2010 and a preliminary analysis of the clinical results is available [40].…”

Section: Patientsmentioning

confidence: 99%