title: Prevention of malignant seeding at drain sites by hypofractionated radiotherapy in patients with pleural mesothelioma.
abstract: OBJECTIVE
  Unlike most other malignancies, malignant pleural mesothelioma (MPM) has a tendency to recur along tracks of chest wall instrumentation. We investigated the efficiency of hypofractionated radiotherapy for prevention of malignant seeding.
  
  
  METHODS
  Twenty-one (six female, 15 male) patients diagnosed with pleural mesothelioma who had chest wall instrumentation and were treated with prophylactic radiotherapy were investigated retrospectively. All patients underwent surgery or thoracoscopy and/or talc pleurodesis, for diagnosis, staging procedures or as a treatment. All were treated with electron (12 MeV) external beam radiation therapy (21 Gy in three fractions over 3 days), directed to the instrumentation pathway after the invasive procedure. After completion of radiotherapy, four of 21 patients had also undergone chemotherapy.
  
  
  RESULTS
  Nineteen of 21 patients were followed-up for a median period of 13 months (1-24 months) and two patients were lost just after the first month of the follow-up period. None of the followed patients had tumor progression in the treated area. Radiotherapy was well tolerated. The most common side-effect was grade 1 erythema (Radiation Therapy Oncology Group [RTOG] scale), noted in 13 treated patients.
  
  
  CONCLUSIONS
  Our experience showed that prophylactic radiotherapy to prevent malignant seeding in malignant mesothelioma at invasive procedure sites was effective and well tolerated in preventing malignant seeding, painful metastases after surgery or instrumentation in patients with pleural mesothelioma. Larger multicenter prospective trials are still needed to validate this treatment approach utility for it to be recommended routinely.
authors.affiliation: Department of Radiation Oncology, Ankara Oncology Research and Education Hospital, Ankara, Turkey. pinarkara04@yahoo.com
authors.forename: Pinar
authors.initials: P
authors.lastname: Kara
authors.forename: Işil
authors.initials: I
authors.lastname: Ugur
authors.forename: Cem
authors.initials: C
authors.lastname: Misirlioglu
authors.forename: Bülent
authors.initials: B
authors.lastname: Kücükplakci
authors.forename: Aytul
authors.initials: A
authors.lastname: Ozgen
authors.forename: Yesim
authors.initials: Y
authors.lastname: Elgin
authors.forename: Taciser
authors.initials: T
authors.lastname: Demirkasimoglu
authors.forename: Ergun
authors.initials: E
authors.lastname: Sanri
mesh_terms: D000328:Adult; D000368:Aged; D019583:Dose Fractionation, Radiation; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D008875:Middle Aged; D009366:Neoplasm Seeding; D009367:Neoplasm Staging; D010997:Pleural Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000009:adverse effects*