A Phase II Trial of Surgical Resection and Adjuvant High-Dose Hemithoracic Radiation for Malignant Pleural Mesothelioma

J Thorac Cardiovasc Surg. 2001 Oct;122(4):788-95. doi: 10.1067/mtc.2001.116560.

Abstract

Background: Surgical resection of malignant pleural mesothelioma is reported to have up to an 80% rate of local recurrence. We performed a phase II trial of high-dose hemithoracic radiation after complete resection to determine feasibility and to estimate rates of local recurrence and survival.

Methods: Patients were eligible if they had a resectable tumor, as determined by computed tomographic scanning, and adequate cardiopulmonary function for extrapleural pneumonectomy or pleurectomy/decortication. After complete resection, patients received hemithoracic radiation (54 Gy) and then were followed up with serial computed tomographic scanning.

Results: From 1995 to 1998, 88 patients (73 men and 15 women; median age, 62.5 years) were entered into the study. The operations performed included 62 extrapleural pneumonectomies (70%) and 5 pleurectomies/decortications; procedures for exploration only were performed in 21 patients. Seven (7.9%) patients died postoperatively. Adjuvant radiation administered to 57 patients (54 undergoing extrapleural pneumonectomy and 3 undergoing pleurectomy/decortication) at a median dose of 54 Gy was well tolerated (grade 0-2 fatigue, esophagitis), except for one late esophageal fistula. The median survival was 33.8 months for stage I and II tumors but only 10 months for stage III and IV tumors (P =.04). For the patients undergoing extrapleural pneumonectomy, the sites of recurrence were locoregional in 2, locoregional and distant in 5, and distant only in 30.

Conclusion: Hemithoracic radiation after complete surgical resection at a dose not previously reported is feasible. This approach dramatically reduces local recurrence and is associated with prolonged survival for early-stage tumors. Stage III disease has a high risk of early distant relapse and should be considered for trials of systemic therapy added to this regimen of resection and radiation.

Publication types

  • Clinical Trial
  • Clinical Trial, Phase II

MeSH terms

  • Adult
  • Aged
  • Clinical Protocols
  • Feasibility Studies
  • Female
  • Hemibody Irradiation*
  • Humans
  • Male
  • Mesothelioma / mortality
  • Mesothelioma / radiotherapy*
  • Mesothelioma / surgery*
  • Middle Aged
  • Pleural Neoplasms / mortality
  • Pleural Neoplasms / radiotherapy*
  • Pleural Neoplasms / surgery*
  • Prospective Studies
  • Radiotherapy, Adjuvant
  • Survival Rate