title: A pilot trial of high-dose-rate intraoperative radiation therapy for malignant pleural mesothelioma.
abstract: OBJECTIVE
  To report results of a phase II trial of high-dose-rate intra-operative radiation therapy (HDR-IORT) for malignant pleural mesothelioma (MPM).
  
  
  METHODS
  Seven patients had extrapleural pneumonectomy with IORT (EPP/IORT) and 6 patients had pleurectomy/decortication with IORT (PD/IORT) between 1994 and 1996. IORT was delivered with 192Ir using a customized applicator with a remote afterloader. A median of 3 sites were treated to a median area of 143 cm2. A dose of 1500 cGy was prescribed at each site, with 1000 cGy delivered to the mediastinum. Postoperative external beam radiation therapy (EBRT) was given 3-5 weeks later. Median follow-up was 8 months (range, 1-84 months).
  
  
  RESULTS
  Five patients developed local failure. Two-year local control and survival rates were 35% and 23%, respectively. Mortality was 2/13 (15%), 1 from each surgical group. Serious complications requiring further intervention occurred in 3/6 (50%) of the EPP/IORT group and 1/5 (20%) of the PD/IORT group.
  
  
  CONCLUSIONS
  HDR-IORT after EPP for MPM is prohibitively toxic and has been abandoned, while its use with PD remains in question.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. rosenzwk@mskcc.org
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Rosenzweig
authors.forename: Jana L
authors.initials: JL
authors.lastname: Fox
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zelefsky
authors.forename: Adam
authors.initials: A
authors.lastname: Raben
authors.forename: Louis B
authors.initials: LB
authors.lastname: Harrison
authors.forename: Valerie W
authors.initials: VW
authors.lastname: Rusch
mesh_terms: D006801:Humans; D007430:Intraoperative Care; D008654:Mesothelioma / Q000532:radiotherapy* / Q000601:surgery*; D010865:Pilot Projects; D010997:Pleural Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D011879:Radiotherapy Dosage