The role of radiation therapy in malignant pleural mesothelioma: A systematic review

Ung, Yee C.; Yu, Edward; Falkson, Conrad; Haynes, Adam E.; Stys-Norman, Denise; Evans, William K.

doi:10.1016/j.radonc.2006.06.002

Cited by 59 publications

(45 citation statements)

References 19 publications

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“…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].…”

Section: Combined-modality Therapymentioning

confidence: 99%

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

Schil

Opitz²,

Weder³

et al. 2014

European Respiratory Journal

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The prognosis of patients with malignant pleural mesothelioma remains poor and although it is clear that multimodal therapy is necessary to improve long-term results, precise treatment schemes have not yet been unequivocally established. Single-modality therapy does not have a major impact on long-term survival and combined-modality therapies are being further evaluated. However, the relative contributions of chemotherapy, radiotherapy and surgery have not been clearly determined at the present time. Moreover, the extent of resection and precise surgical procedure remain a highly debated topic. To better compare and combine results from different institutions and trials, uniform definitions of surgical procedures including extrapleural pneumonectomy and different forms of pleurectomy have recently been introduced. Due to the relatively higher morbidity and mortality of extrapleural pneumonectomy, there is currently a shift towards pleurectomy/decortication when a macroscopic complete resection of all tumour can be obtained by this procedure. In most recent trials, induction chemotherapy was administered to improve surgical resection rates but pathological complete responses are infrequently observed. The role of post-operative radiotherapy has to be further elucidated.Further treatment options that are currently explored include hyperthermic intrapleural chemotherapy, immunotherapy, gene therapy and photodynamic therapy. However, no randomised comparisons are available yet. @ERSpublications Treatment of malignant pleural mesothelioma remains controversial

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Section: Combined-modality Therapymentioning

confidence: 99%

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

Schil

Opitz²,

Weder³

et al. 2014

European Respiratory Journal

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“…MPM is one of the most challenging tumor entities in oncology that requires a multidisciplinary approach 7 , 8 , 9 , 10 . The large target volume that comprises the complete operated hemithorax with its complex shape and the proximity of many sensitive risk structures forces the radiation oncologist to use very sophisticated methods.…”

Section: Discussionmentioning

confidence: 99%

A pilot study of volumetric‐modulated arc therapy for malignant pleural mesothelioma

Cao

Wang

2016

J Applied Clin Med Phys

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Malignant pleural mesothelioma (MPM) is an extremely difficult disease to treat. This pilot study investigates the feasibility of using volumetric‐modulated arc therapy (VMAT) for malignant pleural mesothelioma (MPM), and compares VMAT to static field intensity‐modulated radiotherapy (IMRT) for five patients. To identify the best treatment technique for MPM, in five patients, we made a representative comparative analysis of two kinds of techniques for radiation therapy planning: IMRT and VMAT. The plans were created for an Elekta Synergy linear accelerator with 6 MV photons using Oncentra version 4.3 treatment planning system. Dose prescription was 50 Gy to the average of the planning target volume (PTV). PTV coverage and homogeneity, dose of organs at risk, numbers of segments, MUs, and delivery time were evaluated for all techniques. VMAT allowed better homogeneous and conformity indices compared with IMRT (HI=0.17 vs. 0.12, CI=0.64 vs. 0.77, respectively, p<0.05). VMAT plan had a significantly shorter delivery time (326 s) compared with in IMRT plans (510 s), (p<0.05). In the dose verification, an average of 93.16% of the detector points passed the 3%/3 mmγ criterion for VMAT plans, while in IMRT plans the dose verification was 95.12%.(p>0.05).PACS number(s): 87.55.D, 87.55.km, 87.56.Fc

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“…[8,9] Surgery and radiotherapy have a very limited role in the treatment of patients with advanced MPM and chemotherapy is the only potential treatment option for the majority of people diagnosed with mesothelioma. [10] A trimodality therapeutic approach, utilizing chemotherapy, surgery and hemithoracic radiotherapy, has recently been proposed for the treatment of MPM, with good preliminary results. [11][12][13] The median survival was reported as 11 months.…”

Section: Discussionmentioning

confidence: 99%

“…One of the challenges for individualized radiation in this kind of tumor is that the target field is large and surrounds almost the entire lung. Ung et al (2006), [10] in their systematic review of the literature on this topic, concluded that hemithoracic radiation, without definitive surgery, results in significant toxicity including radiation pneumonitis, lung fibrosis and bronchopleural fistula, without any survival benefit. In their series however, treatment did not spare the lung parenchyma.…”

Section: Discussionmentioning

confidence: 99%

Contemporary radiation therapy techniques in malignant pleural mesothelioma: a case report

Halpern¹,

McVorran

Loksen

2015

JST

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Malignant pleural mesothelioma (MPM) is a rare but very aggressive neoplasm. Prognosis is poor and the disease is fatal within 4-8 months without treatment. Even with a trimodality treatment approach, which has been shown to produce significant morbidity, median survival does not exceed 11 months. There is a need therefore for exploring new treatment options that can improve both qualitative and quantitative outcomes.This case report describes locally advanced malignant pleural mesothelioma treated with a unique, customized irradiation technique involving a combination of 3D conformal therapy and intensity modulated radiotherapy (IMRT). This allowed for treatment of the pleura to a high dose, while sparing the lung parenchyma. In this patient, our approach resulted in a prolonged remission. It is our hope that this stimulates new interest in the use of modern day radiation techniques in the treatment of MPM.

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The role of radiation therapy in malignant pleural mesothelioma: A systematic review

Cited by 59 publications

References 19 publications

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

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

A pilot study of volumetric‐modulated arc therapy for malignant pleural mesothelioma

Contemporary radiation therapy techniques in malignant pleural mesothelioma: a case report

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