Emilio Minatel1, Marco Trovo2, Jerry Polesel3, Tania Baresic4, Alessandra Bearz5, Giovanni Franchin1, Carlo Gobitti1, Imad Abu Rumeileh1, Annalisa Drigo6, Paolo Fontana7, Vittore Pagan8, Mauro G Trovo1. 1. Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Italy. 2. Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Italy. Electronic address: marcotrovo33@hotmail.com. 3. Department of Epidemiology and Biostatistics, Centro di Riferimento Oncologico of Aviano, Italy. 4. Department of Nuclear Medicine, Centro di Riferimento Oncologico of Aviano, Italy. 5. Department of Medical Oncology, Centro di Riferimento Oncologico of Aviano, Italy. 6. Department of Medical Physics, Centro di Riferimento Oncologico of Aviano, Italy. 7. Department of Thoracic Surgery, Mestre General Hospital, Italy. 8. Department of Surgery, Centro di Riferimento Oncologico of Aviano, Italy.
Abstract
PURPOSE: We have previously shown the feasibility of delivering high doses of radiotherapy in malignant pleural mesothelioma (MPM) patients who underwent radical pleurectomy/decortication (P/D) or surgical biopsy. In this report, we present the long-term results of MPM patients treated with radical P/D followed by high doses of radiotherapy. METHODS AND MATERIALS: Twenty consecutive MPM patients were enrolled in this prospective study and underwent radical P/D followed by high dose radiotherapy. The clinical target volume was defined as the entire hemithorax excluding the intact lung. The dose prescribed was 50 Gy in 25 fractions. Any FDG-avid areas or regions of particular concern for residual disease were given a simultaneous boost to 60 Gy. Nineteen patients received cisplatin/pemetrexed chemotherapy. Kaplan-Meier analysis was used to calculate rates of overall survival (OS), progression-free survival (PFS), and loco-regional control (LRC). RESULTS: The median follow-up was of 27 months. The median OS and PFS were 33 and 29 months, respectively. The median LRC was not reached. The Kaplan-Meier estimates of OS at 2 and 3 years were 70% and 49%, respectively. The estimates of PFS at 2 and 3 years were 65% and 46%, respectively. The estimates of LRC at 2 and 3 years were 68% and 59%, respectively. The predominant pattern of failure was distant: 7 patients developed distant metastases as the first site of relapse, whereas only 3 patients experienced an isolated loco-regional recurrence. No fatal toxicity was reported. Five Grades 2-3 pneumonitis were documented. CONCLUSIONS: High dose radiation therapy following radical P/D led to excellent loco-regional control and survival results in MPM patients. A median OS of 33 months and a 3-year OS rate of 49% are among the best observed in recent studies, supporting the idea that this approach represents a concrete therapeutic option for malignant pleural mesothelioma.
PURPOSE: We have previously shown the feasibility of delivering high doses of radiotherapy in malignant pleural mesothelioma (MPM) patients who underwent radical pleurectomy/decortication (P/D) or surgical biopsy. In this report, we present the long-term results of MPM patients treated with radical P/D followed by high doses of radiotherapy. METHODS AND MATERIALS: Twenty consecutive MPM patients were enrolled in this prospective study and underwent radical P/D followed by high dose radiotherapy. The clinical target volume was defined as the entire hemithorax excluding the intact lung. The dose prescribed was 50 Gy in 25 fractions. Any FDG-avid areas or regions of particular concern for residual disease were given a simultaneous boost to 60 Gy. Nineteen patients received cisplatin/pemetrexed chemotherapy. Kaplan-Meier analysis was used to calculate rates of overall survival (OS), progression-free survival (PFS), and loco-regional control (LRC). RESULTS: The median follow-up was of 27 months. The median OS and PFS were 33 and 29 months, respectively. The median LRC was not reached. The Kaplan-Meier estimates of OS at 2 and 3 years were 70% and 49%, respectively. The estimates of PFS at 2 and 3 years were 65% and 46%, respectively. The estimates of LRC at 2 and 3 years were 68% and 59%, respectively. The predominant pattern of failure was distant: 7 patients developed distant metastases as the first site of relapse, whereas only 3 patients experienced an isolated loco-regional recurrence. No fatal toxicity was reported. Five Grades 2-3 pneumonitis were documented. CONCLUSIONS: High dose radiation therapy following radical P/D led to excellent loco-regional control and survival results in MPM patients. A median OS of 33 months and a 3-year OS rate of 49% are among the best observed in recent studies, supporting the idea that this approach represents a concrete therapeutic option for malignant pleural mesothelioma.
Authors: A Botticella; G Defraene; K Nackaerts; C Deroose; J Coolen; P Nafteux; B Vanstraelen; S Joosten; L A W Michiels; S Peeters; D De Ruysscher Journal: Strahlenther Onkol Date: 2017-02-14 Impact factor: 3.621
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Authors: Ellen D Yorke; Andrew Jackson; Li Cheng Kuo; Anthonia Ojo; Kelly Panchoo; Prasad Adusumilli; Marjorie G Zauderer; Valerie W Rusch; Annemarie Shepherd; Andreas Rimner Journal: Int J Radiat Oncol Biol Phys Date: 2017-04-27 Impact factor: 7.038