Dose-Dependent Pulmonary Toxicity After Postoperative Intensity-Modulated Radiotherapy for Malignant Pleural Mesothelioma

Rice, David C.; Smythe, W. Roy; Liao, Zhongxing; Guerrero, Thomas; Chang, Joe Y.; McAleer, Mary Frances; Jeter, Melenda; Correa, Arlene M.; Vaporciyan, Ara A.; Liu, H. Helen; Komaki, Ritsuko; Forster, Kenneth; Stevens, Craig W.

doi:10.1016/j.ijrobp.2007.03.011

Cited by 143 publications

(91 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The MD Anderson series was later updated to 63 irradiated patients of 100 who originally underwent EPP, the remainder having died (11), progressed (15), become unfit (9), or refused (2). In-field recurrence occurred in 3, locoregional failure in 8, but systemic failure in 33 [14]. However, early mortality was significant with 23 deaths within 6 months, including 10 from recurrence, 4 from pneumonia, 2 from pneumonitis, 2 from pulmonary embolism, and 1 from a bronchopleural fistula, with the volume of lung receiving 20 Gy or greater (V 20 One patient died from radiation pneumonitis with a lung V 20 of 7% and volume of lung receiving 5 Gy or greater (V 5 ) of 92%.…”

Section: Intensity Modulated Radiotherapymentioning

confidence: 99%

What Is the Role of Radiotherapy in Malignant Pleural Mesothelioma?

Price

2011

The Oncologist

View full text Add to dashboard Cite

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

show abstract

Section: Intensity Modulated Radiotherapymentioning

confidence: 99%

What Is the Role of Radiotherapy in Malignant Pleural Mesothelioma?

Price

2011

The Oncologist

View full text Add to dashboard Cite

show abstract

“…However, some studies showed that this positive result is at the cost of increased contralateral lung toxicity. 6,12,18 Allen et al reported unacceptable mortality due to RT pneumonia in the 6 patients of their cohort.…”

Section: Discussionmentioning

confidence: 91%

“…First, it is now known that lung dose constraints used in lung cancer RT are not capable of predicting radiation pneumonia in patients with MPM. 6,12,18 Second, new dosimetric limits are needed to determine the tolerance levels of the lung for the safe treatment of patients with mesothelioma who must live with only 1 lung.…”

Section: Discussionmentioning

confidence: 99%

“…The range of gantry angles was 0 to 342 in patients with right-sided disease and 18 to 216 in patients with left-sided disease. Dose-volume constraints were applied as follows-no volume of spinal cord receiving more than 50 Gy, keeping the volume of the heart receiving 45 Gy below 30% and limiting the mean heart dose below 40 Gy and the MLD below 10 Gy.…”

Section: Intensity-modulated Radiation Therapy Planning Techniquementioning

confidence: 99%

See 1 more Smart Citation

Intensity-Modulated Radiation Therapy Improves the Target Coverage Over 3-D Planning While Meeting Lung Tolerance Doses for All Patients With Malignant Pleural Mesothelioma

Ülger

Cetin

Çatlı

et al. 2016

Technol Cancer Res Treat

View full text Add to dashboard Cite

Purpose: To investigate high conformality on target coverage and the ability on creating strict lung dose limitation of intensitymodulated radiation therapy in malignant pleural mesothelioma. Patients and Methods: Twenty-four radiation therapy plannings were evaluated and compared with dosimetric outcomes of conformal radiation therapy and intensity-modulated radiation therapy. Hemithoracal radiation therapy was performed on 12 patients with a fraction of 1.8 Gy to a total dose of 50.4 Gy. All organs at risk were contoured. Radiotherapy plannings were differed according to the technique; conformal radiation therapy was planned with conventionally combined photon-electron fields, and intensity-modulated radiation therapy was planned with 7 to 9 radiation beam angles optimized in inverse planning. Strict dose-volume constraints were applied. Results: Intensity-modulated radiation therapy was statistically superior in target coverage and dose homogeneity (intensity-modulated radiation therapyplanning target volume 95 mean 100%; 3-dimensional conformal radiation therapy-planning target volume 95 mean 71.29%, P ¼ .0001; intensity-modulated radiation therapy-planning target volume 105 mean 11.14%; 3-dimensional conformal radiation therapy-planning target volume 105 mean 35.69%, P ¼ .001). The dosimetric results of the remaining lung was below the limitations on intensity-modulated radiation therapy planning data (intensity-modulated radiation therapy-lung mean dose mean 7.5 [range: 5.6%-8.5%]; intensity-modulated radiation therapy-lung V5 mean 55.55% [range: 47%-59.9%]; intensity-modulated radiation therapy-lung V20 mean 4.5% [range: 0.5%-9.5%]; intensity-modulated radiation therapy-lung V13 mean 13.43% [range: 4.2%-22.9%]). Conclusion: With a complex and large target volume of malignant pleural mesothelioma, intensitymodulated radiation therapy has the ability to deliver efficient tumoricidal radiation dose within the safe dose limits of the remaining lung tissue.

show abstract

“…Subsequently, there were concerns about the use of IMRT after pneumonectomy. It appeared that toxicity was associated with the dose of radiation incidentally delivered to the remaining lung (9)(10)(11).…”

Section: Radiation After Eppmentioning

confidence: 99%

Malignant pleural mesothelioma: adjuvant therapy with radiation therapy

Rosenzweig

2017

Ann. Transl. Med.

View full text Add to dashboard Cite

It is a challenge to treat malignant pleural mesothelioma with radiation therapy (RT). For many years, conventional RT was delivered after extrapleural pneumonectomy (EPP) with acceptable results.However, the benefit of RT has never been definitively proven. Intensity modulated radiation therapy (IMRT) has been used, but some of the early experiences revealed fatal toxicity. As experience has increased, it now appears that RT, particularly with IMRT, is both feasible and effective.

show abstract

Dose-Dependent Pulmonary Toxicity After Postoperative Intensity-Modulated Radiotherapy for Malignant Pleural Mesothelioma

Cited by 143 publications

References 28 publications

What Is the Role of Radiotherapy in Malignant Pleural Mesothelioma?

What Is the Role of Radiotherapy in Malignant Pleural Mesothelioma?

Intensity-Modulated Radiation Therapy Improves the Target Coverage Over 3-D Planning While Meeting Lung Tolerance Doses for All Patients With Malignant Pleural Mesothelioma

Malignant pleural mesothelioma: adjuvant therapy with radiation therapy

Contact Info

Product

Resources

About