Locoregional control and toxicity after pleurectomy/decortication and intensity‐modulated pleural radiation therapy in patients with malignant pleural mesothelioma

Abstract

Background: Treatment of malignant pleural mesothelioma (MPM) represents a major challenge for oncologists. Multimodality treatment, which generally involves induction chemotherapy, surgery and radiotherapy have recently shown promising results. The aim of this study was to evaluate the locoregional control and toxicity of intensity modulated radiotherapy (IMRT) after pleurectomy and decortication (P/D) as part of trimodality therapy for patients with locally advanced MPM. Methods: We prospectively analyzed data from 20 patients with MPM treated at a single tertiary-care institution. Initially every patient received induction chemotherapy with platinum-based chemotherapy. After chemotherapy, patients without progression underwent P/D, and if feasible, hemi-thoracic IMRT was administered at a planned dose of 50.4-54 Gy in 28-30 fractions and treated with 9-11 noncoplanar fields. Results: A total of 15 of the 20 enrolled patients underwent P/D followed by IMRT to the hemi-thoracic cavity. The median total radiotherapy dose was 48.7 Gy (23.4-54 Gy). Radiation pneumonitis (RP) developed in nine patients (60%), and of these, two patients (13.3%) experienced G3 or G4 RP. The estimated locoregional-relapse-free survival at two years was 75.9%, and the main pattern of recurrence was distant (72.7%). For the entire cohort median followup was 22.7 months, median progression-free survival was 18.9 months and median overall survival 23.6 months. Conclusions: Platinum-based chemotherapy followed by lung-sparing surgery (P/D) and IMRT is a feasible and safe treatment modality that yields acceptable locoregional control in patients with locally advanced MPM; however, these results should be corroborated in larger studies.

A randomised phase II study of extended pleurectomy/decortication preceded or followed by chemotherapy in patients with early-stage pleural mesothelioma: EORTC 1205

“…Another approach to improve local control to be further investigated is adding intensity-modulated radiotherapy to the pleura, which has been shown to be feasible in two phase 2 trials [ 23 , 24 ] and is currently being investigated in a phase 3 trial [ 25 ]. During surgery, applying hyperthermic intrathoracic chemotherapy may also improve local control, but this modality has not yet been evaluated in a randomised trial, and its early results should be confirmed in controlled studies [ 26 , 27 ].…”

Role of partial pleurectomy and extended pleurectomy/decortication in mesothelioma: a narrative review

“…Intensity modulated pleural radiation therapy has been shown to be safe with an acceptable rate of radiation pneumonitis; together with chemotherapy and PD in has been advocated as a new lung-sparing treatment paradigm for patients with locally advanced MPM, yielding acceptable locoregional control (21,22).…”