title: [Value of tomotherapy in malignant pleural mesothelioma: first clinical results].
abstract: BACKGROUND
  There is little clinical data about the place of helicoidal tomotherapy (HT) in the treatment of malignant pleural mesothelioma (MPM). This new form of intensity modulated radiotherapy (IMRT) has great theoretical advantages in large and complex volumes when compared to "traditional" forms of radiotherapy.
  
  
  METHODS
  Fourteen patients diagnosed with MPM received adjuvant radiotherapy by HT. The patients were treated at the Curie Institute and the René Gauducheau Centre, starting in August 12007. All patients had a complete initial staging, an extrapleural pneumonectomy (EPP), and a minimum follow-up of six months. The median dose prescribed to the surgical cavity was 50 Gy (48-54 Gy) in 2 Gy (1.80-2.07) fractions. High dose regions received concomitant 57 Gy (54-69 Gy) in 2.16 Gy (2.00-2.30 Gy) fractions.
  
  
  RESULTS
  Median follow-up was 12.6 months after ending HT. Seven patients received neoadjuvant chemotherapy (cisplatin or carboplatin, and pemetrexed). Eight patients were staged pT3 and five were staged pN1-2. HT was well tolerated. Two patients had suspected G5 radiation pneumonitis within 6 months of ending HT. Of the 12 patients who survived treatment, six relapsed (in average 5.1 months after HT): distant. Four relapses were distant; two relapses were both local and distant. Three patients died after their initial relapse. After initial diagnosis, the median survival was 18.4 months. A learning curve was observed in the optimization of the dosimetric parameters.
  
  
  CONCLUSIONS
  Helicoidal tomotherapy is a reliable, quite well tolerated, and efficient way of treating MPM patients after an EPP.
authors.affiliation: Service d'Oncologie Radiothérapie, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015 Paris, France. philippe.giraud@egp.aphp.fr
authors.forename: P
authors.initials: P
authors.lastname: Giraud
authors.forename: A
authors.initials: A
authors.lastname: Sylvestre
authors.forename: A
authors.initials: A
authors.lastname: Lisbona
authors.forename: S
authors.initials: S
authors.lastname: Zefkili
authors.forename: P
authors.initials: P
authors.lastname: Bonnette
authors.forename: F
authors.initials: F
authors.lastname: Le Pimpec Barthes
authors.forename: J-L
authors.initials: JL
authors.lastname: Michaud
authors.forename: C
authors.initials: C
authors.lastname: Perigaud
authors.forename: M-A
authors.initials: MA
authors.lastname: Mahé
mesh_terms: D000328:Adult; D000368:Aged; D016190:Carboplatin / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D005971:Glutamates / Q000008:administration & dosage; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D059032:Learning Curve; D008297:Male; D008654:Mesothelioma / Q000188:drug therapy / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D000068437:Pemetrexed; D010997:Pleural Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D017564:Radiation Pneumonitis / Q000453:epidemiology / Q000209:etiology; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies
chemical_list: D005971:Glutamates; D000068437:Pemetrexed; D006147:Guanine; D016190:Carboplatin; D002945:Cisplatin