title: Current readings: improvements in intensity-modulated radiation therapy for malignant pleural mesothelioma.
abstract: The treatment of malignant pleural mesothelioma with radiation therapy has always been a technical challenge. Early experience with intensity-modulated radiation therapy demonstrated troubling toxicity. Recent reports from institutions have demonstrated that with greater experience, intensity-modulated radiation therapy can be delivered safely, both in the setting of pneumonectomy or pleurectomy. After pneumonectomy, the dose to the contralateral lung must be minimized, preferably with a volume of lung receiving 20 Gy (V20) to less than 5% and a mean lung dose of approximately 10%. In the setting of 2 intact lungs, the mean lung dose can be as high as 20 Gy. Expected rates of grade 3 or worse radiation pneumonitis are 12%-20%. The rates of fatal pneumonitis are approximately 3%-8% in these studies, which demonstrate the considerable toxicity of treatment, even with improved technique.
authors: Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.. Electronic address: Kenneth.rosenzweig@mountsinai.org.
authors: Kenneth E
authors: KE
authors: Rosenzweig
mesh_terms: D004307:Dose-Response Relationship, Radiation; D006801:Humans; D008654:Mesothelioma / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D018365:Neoplasm, Residual; D010997:Pleural Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D011013:Pneumonectomy; D017564:Radiation Pneumonitis / Q000209:etiology; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000401:mortality; D012307:Risk Factors; D016896:Treatment Outcome
keywords: intensity-modulated radiation therapy; mesothelioma; radiation pneumonitis; radiotherapy