title: Tomotherapy after pleurectomy/decortication or biopsy for malignant pleural mesothelioma allows the delivery of high dose of radiation in patients with intact lung.
abstract: BACKGROUND
  This study aimed to assess the safety of high doses of radiation delivered with tomotherapy to the intact lung after radical pleurectomy/decortication or biopsy for malignant pleural mesothelioma (MPM).
  
  
  METHODS
  Twenty-eight patients were enrolled in this prospective study and underwent adjuvant or definitive tomotherapy after radical pleurectomy/decortication (n = 20) or pleural biopsy (n = 8) for MPM. The dose prescribed to the planning target volume, defined as the entire hemithorax, including chest-wall incisions and drain sites and excluding the intact lung, was 50 Gy delivered in 25 fractions. All patients underwent fluorodeoxyglucose-positron emission tomography for staging after surgery. Any fluorodeoxyglucose-avid areas or regions of particular concern for residual disease were given a simultaneous boost of radiotherapy to 60 Gy. Specific lung dosimetric parameters were reported. Toxicity was graded using the modified Common Toxicity Criteria version 3.0.
  
  
  RESULTS
  The median follow-up was of 19 months (range, 6-29 months). Five patients (17.8%) experienced severe respiratory symptoms corresponding to grade 2 pneumonitis in three cases, and grade 3 pneumonitis in two cases. No fatal respiratory toxicity was reported. Controlateral lung V5 was strongly correlated with the risk of pneumonitis. Patients who developed grade 2 and 3 pneumonitis had a higher controlateral lung V5 (mean V5=32%) than those without pneumonitis (mean V5=17%) (p=0.002). Other two grade 3 toxicities were registered: one severe pain to the chest wall, and one severe thrombocytopenia.
  
  
  CONCLUSIONS
  Tomotherapy allows the safe delivery of high dose of radiation to the hemithorax of MPM patients with intact lung.
authors.affiliation: Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Minatel
authors.affiliation: Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Italy. Electronic address: marcotrovo33@hotmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Trovo
authors.affiliation: Department of Epidemiology and Biostatistics, Centro di Riferimento Oncologico of Aviano, Italy.
authors.forename: Jerry
authors.initials: J
authors.lastname: Polesel
authors.affiliation: Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Italy.
authors.forename: Imad Abu
authors.initials: IA
authors.lastname: Rumeileh
authors.affiliation: Department of Nuclear Medicine, Centro di Riferimento Oncologico of Aviano, Italy.
authors.forename: Tania
authors.initials: T
authors.lastname: Baresic
authors.affiliation: Department of Medical Oncology, Centro di Riferimento Oncologico of Aviano, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bearz
authors.affiliation: Department of Medical Oncology, Pordenone General Hospital, Pordenone, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Del Conte
authors.affiliation: Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Franchin
authors.affiliation: Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Gobitti
authors.affiliation: Department of Medical Physics, Centro di Riferimento Oncologico of Aviano, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Drigo
authors.affiliation: Department of Medical Physics, Centro di Riferimento Oncologico of Aviano, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Dassie
authors.affiliation: Department of Surgery, Centro di Riferimento Oncologico of Aviano, Italy.
authors.forename: Vittore
authors.initials: V
authors.lastname: Pagan
authors.affiliation: Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Italy.
authors.forename: Mauro G
authors.initials: MG
authors.lastname: Trovo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000528:radiation effects* / Q000601:surgery; D008297:Male; D008654:Mesothelioma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D010997:Pleural Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D011013:Pneumonectomy; D049268:Positron-Emission Tomography; D011379:Prognosis; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated; D015996:Survival Rate
chemical_list: D019788:Fluorodeoxyglucose F18