Long-term outcomes of intensity-modulated radiotherapy following extra-pleural pneumonectomy for malignant pleural mesothelioma.

Abstract

BACKGROUND:

The purpose was to evaluate safety and efficacy of intensity-modulated radiotherapy (IMRT) following extra-pleural pneumonectomy (EPP) for malignant pleural mesothelioma (MPM).

MATERIAL AND METHODS:

Patients with MPM of clinical stage I-III, which were macroscopic completely resected with EPP were eligible for this prospective study. The ipsilateral hemithorax was irradiated with a prescribed dose of 50.4 Gy. When the high-risk surgical margins or FDG-avid regions were identified, simultaneous integrated boost (SIB) with 56.0 Gy or 61.6 Gy was applied.

RESULTS:

Twenty-one patients were enrolled. SIB was applied to five patients. The planned IMRT fractions were completed in all, but four patients who suffered from severe fatigue or radiation pneumonitis. With a potential median follow-up of 6.3 years, overall survival was 37.5% at 3 years since the IMRT. The median survival time was 17.5 and 27.0 months since the IMRT and the initial treatment, respectively. Three patients have survived for more than 5 years. Distant metastasis was observed in 15 patients. Local recurrence was also observed in 2 of the 15 patients. Acute toxicities of Grade 3 or worse were observed in 15 patients, including 9 with hematological, 3 with pneumonitis and 6 with fatigue, nausea or vomiting. Five patients developed Grade 3 or worse late toxicities associated with IMRT, consisting of one with persistent Grade 4 thrombocytopenia, one with brain infarction and congestive liver dysfunction, and three with elevation of serum transaminase or biliary enzyme. No Grade 5 toxicity was observed. Patients with N2 showed significantly worse survival than those with N0-1 (18.2% vs. 60.0% at 3 years, p = .014).

CONCLUSION:

IMRT following EPP achieved excellent local control for MPM, that might lead to the long-term survival in selected patients. However, treatment burden including acute and late toxicities should be considered in this treatment approach.

• Authors: Yukinori Matsuo, Keiko Shibuya, Kenichi Okubo, Nami Ueki, Akihiro Aoyama, Makoto Sonobe, Mitsuhiro Nakamura, Takashi Mizowaki, Hiroshi Date, Masahiro Hiraoka
• Journal: Acta oncologica (Stockholm, Sweden) (Acta Oncol) Vol. 56 Issue 7 Pg. 957-962 (Jul 2017) ISSN: 1651-226X [Electronic] England
• PMID: 28117611 (Publication Type: Journal Article)

Topics

• Aged
• Female
• Follow-Up Studies
• Humans
• Lung Neoplasms (pathology, radiotherapy, surgery)
• Male
• Mesothelioma (pathology, radiotherapy, surgery)
• Mesothelioma, Malignant
• Middle Aged
• Neoplasm Recurrence, Local (pathology, radiotherapy, surgery)
• Pleural Neoplasms (pathology, radiotherapy, surgery)
• Pneumonectomy (mortality)
• Prevalence
• Prognosis
• Prospective Studies
• Radiation Pneumonitis (epidemiology)
• Radiotherapy, Intensity-Modulated (mortality)
• Survival Rate