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

Journal Article · Mon Oct 01 04:00:00 EDT 2007 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2007.03.011· OSTI ID:21036233

Smythe, W Roy ^[1]; Zhongxing, Liao; Guerrero, Thomas; Chang, Joe Y; McAleer, Mary F; Jeter, Melenda D ^[2]; Correa, Arlene Ph.D.; Vaporciyan, Ara A ^[3]; Liu, H Helen ^[4]; Komaki, Ritsuko ^[2]; Forster, Kenneth M; Stevens, Craig W ^[5]

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1. Department of Surgery, Texas A and M University Medical School, College Station, TX (United States)
2. Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)
3. Department of Thoracic and Cardiovascular Surgery, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)
4. Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)
5. Division of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL (United States)

Purpose: To determine the incidence of fatal pulmonary events after extrapleural pneumonectomy and hemithoracic intensity-modulated radiotherapy (IMRT) for malignant pleural mesothelioma. Methods and Materials: We retrospectively reviewed the records of 63 consecutive patients with malignant pleural mesothelioma who underwent extrapleural pneumonectomy and IMRT at University of Texas M. D. Anderson Cancer Center. The endpoints studied were pulmonary-related death (PRD) and non-cancer-related death within 6 months of IMRT. Results: Of the 63 patients, 23 (37%) had died within 6 months of IMRT (10 of recurrent cancer, 6 of pulmonary causes [pneumonia in 4 and pneumonitis in 2], and 7 of other noncancer causes [pulmonary embolus in 2, sepsis after bronchopleural fistula in 1, and cause unknown but without pulmonary symptoms or recurrent disease in 4]). On univariate analysis, the factors that predicted for PRD were a lower preoperative ejection fraction (p = 0.021), absolute volume of lung spared at 10 Gy (p = 0.025), percentage of lung volume receiving {>=}20 Gy (V{sub 20}; p 0.002), and mean lung dose (p = 0.013). On multivariate analysis, only V{sub 20} was predictive of PRD (p = 0.017; odds ratio, 1.50; 95% confidence interval, 1.08-2.08) or non-cancer-related death (p = 0.033; odds ratio, 1.21; 95% confidence interval, 1.02-1.45). Conclusion: The results of our study have shown that fatal pulmonary toxicities were associated with radiation to the contralateral lung. V{sub 20} was the only independent determinant for risk of PRD or non-cancer-related death. The mean V{sub 20} of the non-PRD patients was considerably lower than that accepted during standard thoracic radiotherapy, implying that the V{sub 20} should be kept as low as possible after extrapleural pneumonectomy.

• OSTI ID: 21036233
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 2 Vol. 69; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CARCINOMAS
DEATH
HEALTH HAZARDS
LUNGS
MULTIVARIATE ANALYSIS
PATIENTS
PNEUMONIA
PNEUMONITIS
RADIATION DOSES
RADIOTHERAPY
SYMPTOMS
TEXAS
TOXICITY