Radical pleurectomy/decortication Followed by High Dose of Radiation Therapy for Malignant Pleural Mesothelioma. Final Results With Long-Term Follow-Up

Lung Cancer. 2014 Jan;83(1):78-82. doi: 10.1016/j.lungcan.2013.10.013. Epub 2013 Oct 27.

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.

Keywords: IMRT; Intensity modulated radiation therapy; Malignant pleural mesothelioma; Pleurectomy/decortication; Pneumonitis; Tomotherapy.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Lung Neoplasms / radiotherapy*
  • Lung Neoplasms / surgery*
  • Male
  • Mesothelioma / radiotherapy*
  • Mesothelioma / surgery*
  • Middle Aged
  • Neoplasm Staging
  • Pleura / drug effects*
  • Pleura / pathology*
  • Pleura / surgery
  • Pleural Effusion, Malignant / radiotherapy*
  • Pleural Effusion, Malignant / surgery*
  • Thoracic Surgical Procedures*
  • Time Factors
  • Treatment Outcome

Supplementary concepts

  • Mesothelioma, Malignant