Radical pleurectomy/decortication followed by high dose of radiation therapy for malignant pleural mesothelioma. Final results with long-term follow-up.
OBJECTIVE
We have previously shown the feasibility of delivering high doses of radiotherapy in malignant pleural mesothelioma (MPM) patients who underwent radical pleurectomy/decortication (P/D) or surgical biopsy. In this report, we present the long-term results of MPM patients treated with radical P/D followed by high doses of radiotherapy.


METHODS
Twenty consecutive MPM patients were enrolled in this prospective study and underwent radical P/D followed by high dose radiotherapy. The clinical target volume was defined as the entire hemithorax excluding the intact lung. The dose prescribed was 50 Gy in 25 fractions. Any FDG-avid areas or regions of particular concern for residual disease were given a simultaneous boost to 60 Gy. Nineteen patients received cisplatin/pemetrexed chemotherapy. Kaplan-Meier analysis was used to calculate rates of overall survival (OS), progression-free survival (PFS), and loco-regional control (LRC).


RESULTS
The median follow-up was of 27 months. The median OS and PFS were 33 and 29 months, respectively. The median LRC was not reached. The Kaplan-Meier estimates of OS at 2 and 3 years were 70% and 49%, respectively. The estimates of PFS at 2 and 3 years were 65% and 46%, respectively. The estimates of LRC at 2 and 3 years were 68% and 59%, respectively. The predominant pattern of failure was distant: 7 patients developed distant metastases as the first site of relapse, whereas only 3 patients experienced an isolated loco-regional recurrence. No fatal toxicity was reported. Five Grades 2-3 pneumonitis were documented.


CONCLUSIONS
High dose radiation therapy following radical P/D led to excellent loco-regional control and survival results in MPM patients. A median OS of 33 months and a 3-year OS rate of 49% are among the best observed in recent studies, supporting the idea that this approach represents a concrete therapeutic option for malignant pleural mesothelioma.
Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Italy.
Emilio
E
Minatel
Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Italy. Electronic address: marcotrovo33@hotmail.com.
Marco
M
Trovo
Department of Epidemiology and Biostatistics, Centro di Riferimento Oncologico of Aviano, Italy.
Jerry
J
Polesel
Department of Nuclear Medicine, Centro di Riferimento Oncologico of Aviano, Italy.
Tania
T
Baresic
Department of Medical Oncology, Centro di Riferimento Oncologico of Aviano, Italy.
Alessandra
A
Bearz
Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Italy.
Giovanni
G
Franchin
Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Italy.
Carlo
C
Gobitti
Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Italy.
Imad Abu
IA
Rumeileh
Department of Medical Physics, Centro di Riferimento Oncologico of Aviano, Italy.
Annalisa
A
Drigo
Department of Thoracic Surgery, Mestre General Hospital, Italy.
Paolo
P
Fontana
Department of Surgery, Centro di Riferimento Oncologico of Aviano, Italy.
Vittore
V
Pagan
Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Italy.
Mauro G
MG
Trovo
D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D008297:Male; D008654:Mesothelioma / Q000532:radiotherapy* / Q000601:surgery*; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D009367:Neoplasm Staging; D010994:Pleura / Q000187:drug effects* / Q000473:pathology* / Q000601:surgery; D016066:Pleural Effusion, Malignant / Q000532:radiotherapy* / Q000601:surgery*; D019616:Thoracic Surgical Procedures; D013997:Time Factors; D016896:Treatment Outcome
IMRT; Intensity modulated radiation therapy; Malignant pleural mesothelioma; Pleurectomy/decortication; Pneumonitis; Tomotherapy