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Title: Pleural Intensity-Modulated Radiotherapy for Malignant Pleural Mesothelioma

Abstract

Purpose: In patients with malignant pleural mesothelioma who are unable to undergo pneumonectomy, it is difficult to deliver tumoricidal radiation doses to the pleura without significant toxicity. We have implemented a technique of using intensity-modulated radiotherapy (IMRT) to treat these patients, and we report the feasibility and toxicity of this approach. Methods and Materials: Between 2005 and 2010, 36 patients with malignant pleural mesothelioma and two intact lungs (i.e., no previous pneumonectomy) were treated with pleural IMRT to the hemithorax (median dose, 46.8 Gy; range, 41.4-50.4) at Memorial Sloan-Kettering Cancer Center. Results: Of the 36 patients, 56% had right-sided tumors. The histologic type was epithelial in 78%, sarcomatoid in 6%, and mixed in 17%, and 6% had Stage I, 28% had Stage II, 33% had Stage III, and 33% had Stage IV. Thirty-two patients (89%) received induction chemotherapy (mostly cisplatin and pemetrexed); 56% underwent pleurectomy/decortication before IMRT and 44% did not undergo resection. Of the 36 patients evaluable for acute toxicity, 7 (20%) had Grade 3 or worse pneumonitis (including 1 death) and 2 had Grade 3 fatigue. In 30 patients assessable for late toxicity, 5 had continuing Grade 3 pneumonitis. For patients treated with surgery, the 1- and 2-yearmore » survival rate was 75% and 53%, and the median survival was 26 months. For patients who did not undergo surgical resection, the 1- and 2-year survival rate was 69% and 28%, and the median survival was 17 months. Conclusions: Treating the intact lung with pleural IMRT in patients with malignant pleural mesothelioma is a safe and feasible treatment option with an acceptable rate of pneumonitis. Additionally, the survival rates were encouraging in our retrospective series, particularly for the patients who underwent pleurectomy/decortication. We have initiated a Phase II trial of induction chemotherapy with pemetrexed and cisplatin with or without pleurectomy/decortication, followed by pleural IMRT to prospectively evaluate the toxicity and survival.« less

Authors:
 [1];  [2];  [1];  [3];  [4];  [5];  [6];  [7]
  1. Department of Medicine, Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)
  2. Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI (United States)
  3. Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)
  4. Department of Epidemiology/Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)
  5. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)
  6. Department of Surgery, Mount Sinai Medical Center, New York, NY (United States)
  7. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)
Publication Date:
OSTI Identifier:
22058975
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 83; Journal Issue: 4; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CHEMOTHERAPY; DEATH; FATIGUE; GY RANGE 10-100; LUNGS; NEOPLASMS; PATIENTS; PLEURA; PNEUMONITIS; RADIATION DOSES; RADIOTHERAPY; SURGERY; TOXICITY

Citation Formats

Rosenzweig, Kenneth E., E-mail: ken.rosenzweig@mountsinai.org, Zauderer, Marjorie G, Laser, Benjamin, Krug, Lee M, Yorke, Ellen, Sima, Camelia S, Rimner, Andreas, Flores, Raja, and Rusch, Valerie. Pleural Intensity-Modulated Radiotherapy for Malignant Pleural Mesothelioma. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2011.09.027.
Rosenzweig, Kenneth E., E-mail: ken.rosenzweig@mountsinai.org, Zauderer, Marjorie G, Laser, Benjamin, Krug, Lee M, Yorke, Ellen, Sima, Camelia S, Rimner, Andreas, Flores, Raja, & Rusch, Valerie. Pleural Intensity-Modulated Radiotherapy for Malignant Pleural Mesothelioma. United States. https://doi.org/10.1016/J.IJROBP.2011.09.027
Rosenzweig, Kenneth E., E-mail: ken.rosenzweig@mountsinai.org, Zauderer, Marjorie G, Laser, Benjamin, Krug, Lee M, Yorke, Ellen, Sima, Camelia S, Rimner, Andreas, Flores, Raja, and Rusch, Valerie. 2012. "Pleural Intensity-Modulated Radiotherapy for Malignant Pleural Mesothelioma". United States. https://doi.org/10.1016/J.IJROBP.2011.09.027.
@article{osti_22058975,
title = {Pleural Intensity-Modulated Radiotherapy for Malignant Pleural Mesothelioma},
author = {Rosenzweig, Kenneth E., E-mail: ken.rosenzweig@mountsinai.org and Zauderer, Marjorie G and Laser, Benjamin and Krug, Lee M and Yorke, Ellen and Sima, Camelia S and Rimner, Andreas and Flores, Raja and Rusch, Valerie},
abstractNote = {Purpose: In patients with malignant pleural mesothelioma who are unable to undergo pneumonectomy, it is difficult to deliver tumoricidal radiation doses to the pleura without significant toxicity. We have implemented a technique of using intensity-modulated radiotherapy (IMRT) to treat these patients, and we report the feasibility and toxicity of this approach. Methods and Materials: Between 2005 and 2010, 36 patients with malignant pleural mesothelioma and two intact lungs (i.e., no previous pneumonectomy) were treated with pleural IMRT to the hemithorax (median dose, 46.8 Gy; range, 41.4-50.4) at Memorial Sloan-Kettering Cancer Center. Results: Of the 36 patients, 56% had right-sided tumors. The histologic type was epithelial in 78%, sarcomatoid in 6%, and mixed in 17%, and 6% had Stage I, 28% had Stage II, 33% had Stage III, and 33% had Stage IV. Thirty-two patients (89%) received induction chemotherapy (mostly cisplatin and pemetrexed); 56% underwent pleurectomy/decortication before IMRT and 44% did not undergo resection. Of the 36 patients evaluable for acute toxicity, 7 (20%) had Grade 3 or worse pneumonitis (including 1 death) and 2 had Grade 3 fatigue. In 30 patients assessable for late toxicity, 5 had continuing Grade 3 pneumonitis. For patients treated with surgery, the 1- and 2-year survival rate was 75% and 53%, and the median survival was 26 months. For patients who did not undergo surgical resection, the 1- and 2-year survival rate was 69% and 28%, and the median survival was 17 months. Conclusions: Treating the intact lung with pleural IMRT in patients with malignant pleural mesothelioma is a safe and feasible treatment option with an acceptable rate of pneumonitis. Additionally, the survival rates were encouraging in our retrospective series, particularly for the patients who underwent pleurectomy/decortication. We have initiated a Phase II trial of induction chemotherapy with pemetrexed and cisplatin with or without pleurectomy/decortication, followed by pleural IMRT to prospectively evaluate the toxicity and survival.},
doi = {10.1016/J.IJROBP.2011.09.027},
url = {https://www.osti.gov/biblio/22058975}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 4,
volume = 83,
place = {United States},
year = {Sun Jul 15 00:00:00 EDT 2012},
month = {Sun Jul 15 00:00:00 EDT 2012}
}