Factors Influencing the Outcome of Radiotherapy in Malignant Mesothelioma of the Pleura--A Single-Institution Experience With 189 Patients

Int J Radiat Oncol Biol Phys. 1999 Feb 1;43(3):511-6. doi: 10.1016/s0360-3016(98)00409-x.

Abstract

Purpose: To determine the factors influencing the response to palliative radiotherapy (RT) in malignant mesothelioma of the pleura (MM).

Methods and materials: A retrospective review was conducted of the records of all patients with mesothelioma who were referred to our institution between 1979 and 1996. A total of 227 RT series were administered to 189 patients with MM. Of these, 21 patients with chest wall nodules also received concomitant local hyperthermia.

Results: The median survival was 5 months from the start of RT and only 17% of patients were alive at 1 year after treatment. Chest pain and painful chest wall metastases were the main indications for RT. A higher local response rate was seen for patients treated with a 4-Gy per fraction scheme, vs. those receiving fractions of less than 4 Gy (50% vs. 39%). Pain recurrence occurred predominantly within the previous RT field, and pain recurred after a median of 69 days (range 32-363) in the group treated using 4-Gy fractions. When compared with a matched group, patients treated with combined RT and hyperthermia had higher response rates and fewer in-field recurrences.

Conclusions: RT provides local palliation in at least 50% of patients with MM who were treated using a 4-Gy/fraction scheme to a median dose of 36 Gy. The low response rates with RT alone suggest that combined RT and local hyperthermia should be further evaluated in MM.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Combined Modality Therapy
  • Dose Fractionation, Radiation
  • Female
  • Humans
  • Hyperthermia, Induced
  • Male
  • Mesothelioma / drug therapy
  • Mesothelioma / radiotherapy*
  • Mesothelioma / secondary
  • Mesothelioma / therapy
  • Middle Aged
  • Neoplasm Staging
  • Palliative Care
  • Pleural Neoplasms / drug therapy
  • Pleural Neoplasms / pathology
  • Pleural Neoplasms / radiotherapy*
  • Pleural Neoplasms / therapy
  • Prognosis
  • Retrospective Studies
  • Treatment Outcome