High dose irradiation after pleurectomy/decortication or biopsy for pleural mesothelioma treatment

Cancer Radiother. 2017 Dec;21(8):766-773. doi: 10.1016/j.canrad.2017.05.007. Epub 2017 Nov 11.


Purpose: The role played by radiation therapy after pleurectomy/decortication or surgical biopsy in malignant pleural mesothelioma is uncertain. We treated patients with accelerated hypofractionated radiotherapy using helical tomotherapy and intensity-modulated arc therapy in an attempt to keep lung toxicity to a minimum. The present study reports the feasibility and toxicity of this approach.

Material and methods: Between 2008 and 2012, 36 patients with malignant pleural mesothelioma underwent accelerated hypofractionated radiotherapy to the hemithorax after pleurectomy/decortication (19 patients) or biopsy (17 patients). The prescription dose was 25Gy in five fractions over 5 consecutive days.

Results: We observed three patients with G3 pneumonitis, five cases of grade 2 dyspnea and six cases of grade 2 cough. The median follow-up was 37 months (range: 3-54 months). The median overall survival for patients who underwent pleurectomy/decortication followed by radiotherapy was 21.6 months [95% confidence interval (95% CI): 15.5-24.1] compared to 19.4 months for patients not submitted to surgery.

Conclusion: Treatment of intact lung with pleural intensity-modulated arc irradiation in malignant pleural mesothelioma patients with malignant pleural mesothelioma proved safe and feasible, with an acceptable rate of pneumonitis. Survival rates were encouraging for both biopsy-only and pleurectomy/decortication groups. We are currently conducting a phase II dose escalation trial in a similar patient setting to prospectively evaluate the impact of radiotherapy on toxicity, disease-free survival and overall survival.

Keywords: Accelerated hypofractionated radiotherapy; Helical tomotherapy; Malignant pleural mesothelioma; Mésothéliome pleural malin; Pleurectomie/décortication; Pleurectomy/decortication; Radiothérapie hypofractionnée accélérée; Tomothérapie hélicoïdale.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy
  • Combined Modality Therapy
  • Female
  • Humans
  • Lung Neoplasms / pathology
  • Lung Neoplasms / radiotherapy*
  • Lung Neoplasms / surgery*
  • Male
  • Mesothelioma / pathology
  • Mesothelioma / radiotherapy*
  • Mesothelioma / surgery*
  • Mesothelioma, Malignant
  • Middle Aged
  • Pleura / surgery*
  • Pleural Neoplasms / pathology
  • Pleural Neoplasms / radiotherapy*
  • Pleural Neoplasms / surgery*
  • Radiation Dose Hypofractionation*
  • Radiotherapy, Intensity-Modulated*
  • Retrospective Studies