Radical Radiation Therapy After Lung-Sparing Surgery for Malignant Pleural Mesothelioma: Survival, Pattern of Failure, and Prognostic Factors

Journal Article · Sun Nov 01 04:00:00 EST 2015 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2015.06.029· OSTI ID:22644984

Minatel, Emilio ^[1]; Trovo, Marco ^[1]; Bearz, Alessandra ^[2]; Di Maso, Matteo ^[3]; Baresic, Tania ^[4]; Drigo, Annalisa; Barresi, Loredana ^[5]; Furlan, Carlo ^[1]; Del Conte, Alessandro ^[6]; Bruschi, Gioia ^[7]; Fontana, Paolo ^[8]; Pagan, Vittore ^[9]; Franchin, Giovanni ^[1]

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1. Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy)
2. Department of Medical Oncology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy)
3. Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico of Aviano, Aviano (Italy)
4. Department of Nuclear Medicine, Centro di Riferimento Oncologico of Aviano, Aviano (Italy)
5. Department of Medical Physics, Centro di Riferimento Oncologico of Aviano, Aviano (Italy)
6. Department of Medical Oncology, Pordenone General Hospital, Pordenone (Italy)
7. Department of Pneumology, Pordenone General Hospital, Pordenone (Italy)
8. Department of Thoracic Surgery, Mestre General Hospital, Mestre (Italy)
9. Department of Surgery, Centro di Riferimento Oncologico of Aviano, Aviano (Italy)

Purpose: To prospectively assess the survival, patterns of failure, and prognostic factors in a large cohort of patients with malignant pleural mesothelioma who had undergone a novel trimodal therapeutic approach, including lung-sparing surgery, chemotherapy, and subsequent treatment with high doses of intensity modulated radiation therapy (IMRT) to the whole hemithorax. Methods and Materials: The analysis was conducted on the data from 69 patients. Of the 69 patients, 35 underwent extended pleurectomy/decortication (P/D), with resection of the entire pleura, along with portions of the pericardium and diaphragm and 34, partial pleurectomy, defined as partial removal of parietal or visceral pleura for diagnostic purposes, leaving gross tumor behind in all cases. All patients received cisplatin/pemetrexed chemotherapy. Postoperative IMRT was delivered to the entire hemithorax, excluding the intact lung. The IMRT dose was 50 Gy in 25 fractions. Any fluorodeoxyglucose-avid areas or regions of particular concern for residual disease were given a simultaneous boost to 60 Gy. Results: The median follow-up duration was 19 months. No difference was seen in overall survival and locoregional control between the extended P/D group and the partial pleurectomy group. The 2-year overall survival was 65% and 58% in the extended P/D and partial pleurectomy groups, respectively (P=.94). Locoregional control at 2 years was 65% and 64% in the extended P/D and partial pleurectomy groups, respectively (P=.75). The predominant pattern of failure was distant: 19 patients (27.5%) developed distant metastases as the first site of relapse. Gross residual disease after surgery was significantly associated with overall survival (hazard ratio 3.45). One fatal pneumonitis was reported; 14 cases (20%) of grade 2 to 3 pneumonitis were documented. Conclusions: Radical IMRT after lung-sparing surgery and chemotherapy for malignant pleural mesothelioma leads to promising survival results and acceptable toxicity rates. The similarity of survival between patients treated with extended P/D or partial pleurectomy observed in our study is intriguing.

• OSTI ID: 22644984
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 3 Vol. 93; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

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