title: Clinical experience of volumetric modulated arc therapy for malignant pleural mesothelioma after extrapleural pneumonectomy.
abstract: The purpose of this study was to evaluate the efficacy and safety of volumetric modulated arc therapy (VMAT) after extrapleural pneumonectomy (EPP) in patients with malignant pleural mesothelioma (MPM). A total of 15 patients who received VMAT after EPP were enrolled. All patients were males, and the median age was 67 years (Stage IB in two, II in six, and III in seven patients). The clinical target volume (CTV) included the entire preoperative ipsilateral hemithorax and involved nodal stations. The CTV was generally expanded by 10-15 mm beyond the planning target volume (PTV). The dose prescription was designed to cover 95% of the PTV with 54 Gy in 30 fractions. The median follow-up period was 11 months. Treatment-related toxicities were evaluated by Common Terminology Criteria for Adverse Events (CTCAE) ver. 4. One-year local control, disease-free survival, and overall survival rates were 55.7% [95% confidence interval (CI): 25.6-85.8%], 29.3% (95% CI: 5.3-53.3%), and 43.1% (95% CI: 17.1-69.0%), respectively. According to the histological analysis, the one-year LC rate was significantly worse in patients with non-epithelial type (biphasic and sarcomatoid types) than in patients with epithelial type [epithelial type: 83.3% (95% CI, 53.5-100%), non-epithelial type: 0% (95% CI, 0%), P = 0.0011]. Grade 3 pneumonitis after VMAT was observed in three patients (20.0%); however, no patients died of pulmonary toxicity. VMAT appears to be relatively safe for patients with MPM after EPP because of the low pulmonary dose.
authors.affiliation: Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima City, 734-8551, Japan tkkimura@hiroshima-u.ac.jp.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima City, 734-8551, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Doi
authors.affiliation: Division of Radiation Oncology, Hiroshima University Hospital.
authors.forename: Takeo
authors.initials: T
authors.lastname: Nakashima
authors.affiliation: Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima City, 734-8551, Japan.
authors.forename: Nobuki
authors.initials: N
authors.lastname: Imano
authors.affiliation: Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima City, 734-8551, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Katsuta
authors.affiliation: Department of Radiation Oncology, Kagawa University Hospital.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima City, 734-8551, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kenjo
authors.affiliation: Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima City, 734-8551, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ozawa
authors.affiliation: Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima City, 734-8551, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Murakami
authors.affiliation: Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima City, 734-8551, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Nagata
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis / Q000628:therapy*; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D010997:Pleural Neoplasms / Q000175:diagnosis / Q000628:therapy*; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: extrapleural pneumonectomy (EPP); malignant pleural mesothelioma (MPM); radiation pneumonitis; volumetric modulated arc therapy (VMAT)