Early experience with intensity modulated proton therapy for lung-intact mesothelioma: A case series

National Cancer Database Report on Pneumonectomy Versus Lung-Sparing Surgery for Malignant Pleural Mesothelioma

“…26 Although concern for radiation pneumonitis is heightened during delivery of adjuvant RT after a lung-sparing surgical procedure because of the near-uniform volume of ipsilateral lung receiving clinically significant doses of irradiation, recent data demonstrate that use of intensity-modulated RT has substantial utility and promise as part of multidisciplinary lung-sparing management. 27 Similarly, another advanced RT technique, proton therapy, may also allow for safe delivery of adjuvant treatment in the setting of a lung-sparing surgery 28 given the dosimetric benefit of protons in reducing doses to lungs and other organs at risk compared with photons when administered for thoracic malignancies. 29,30 Total RT dose, when analyzed as a continuous variable, independently predicted for higher OS when a multivariable Cox proportional hazards model was used, indicating the potential of dose escalation when feasible.…”

Heart Dosimetry is Correlated With Risk of Radiation Pneumonitis After Lung-Sparing Hemithoracic Pleural Intensity Modulated Radiation Therapy for Malignant Pleural Mesothelioma

“…Superior contralateral lung and heart doses from proton therapy may reduce toxicity for future patients 21,22 and suggest dosimetric improvements for photon treatments. Its major strength is that it represents the single most exhaustive analysis of dosimetric predictors of RP in patients treated with IMPRINT.…”

The Use of Radiation Therapy for the Treatment of Malignant Pleural Mesothelioma: Expert Opinion from the National Cancer Institute Thoracic Malignancy Steering Committee, International Association for the Study of Lung Cancer, and Mesothelioma Applied Research Foundation

“…They found that PBS plans led to lower mean doses to the contralateral lung, esophagus, liver, heart, and ipsilateral kidney and that all four patients who received PBS tolerated it well without requiring treatment breaks. 34 In a report on proton therapy for MPM from investigators at the University of Pennsylvania, 16 patients with MPM received 17 courses of proton therapy as adjuvant therapy after lung-sparing radical pleurectomy (n ¼ 8), to sites of gross disease after progression on prior chemotherapy (n ¼ 8), or as initial definitive therapy concurrently with chemotherapy (n ¼ 1). The median proton dose was 51.75 Gy (relative biological effectiveness [RBE]) in 2.0-Gy (RBE) daily fractions (range 50.0À75.0 Gy [RBE] in 1.8-to 2.5-Gy fractions).…”