title: Intensity modulated radiation therapy after extra-pleural pneumonectomy for malignant pleural mesothelioma is feasible without fatal pulmonary toxicity and provides good survival.
abstract: OBJECTIVE
  To analyze patterns of failure, toxicity, relapse-free survival (RFS), and overall survival (OS) in malignant pleural mesothelioma (MPM) patients treated with intensity-modulated radiation therapy following extrapleural pneumonectomy (EPP).
  
  
  METHODS
  We reviewed 18 charts of patients with MPM from 2005 to 2014 who underwent EPP followed by hemithoracic intensity-modulated radiation therapy. Intensity-modulated radiation therapy dose delivery adhered to published lung dose constraints. Kaplan-Meier curves were used to assess the RFS and OS. Median survival times are reported for both RFS and OS.
  
  
  RESULTS
  Median age was 65 years (range: 40-76 years). Chemotherapy was administered in four neo-adjuvant and seven adjuvant patients. Pathological American Joint Committee on Cancer stages II, III, IV, surgical margin, lympho-vascular space, pericardium, and chest wall involvement were seen in 3, 12, 3, 9, 7, 12 and 3 patients, respectively. The majority of the patients received 45 Gy in 25 fractions. The mean lung dose was 7.14 Gy (range: 5 Gy-9.3 Gy). The mean V20 was 2.23%. At a median follow-up of 3 years, eight patients were alive (44%); 10 experienced relapse (56%). Median RFS and OS were 24.4 months (95% CI: >16.3 months) and 38.2 months (95% CI: 17.4-78.1 months), respectively. Acute toxicities were fatigue, dermatitis, nausea, esophagitis/dysphagia, cough, and dyspnea on exertion. No grade III, IV, or fatal pulmonary toxicities were observed.
  
  
  CONCLUSIONS
  Intensity-modulated radiation therapy following EPP for MPM resulted in RFS and OS comparable to the published literature without significant toxicity.
authors.affiliation: Department of Radiation Oncology, Baylor Scott and White Health, Temple, Texas, USA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Jhavar
authors.affiliation: Biostatistics, Baylor Scott and White Health, Temple, Texas, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Pruszynski
authors.affiliation: Hematology and Oncology, Baylor Scott and White Health, Temple, Texas, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Gowan
authors.affiliation: Radiation Oncology, Austin Cancer Centers, Texas, USA.
authors.forename: Teresa
authors.initials: T
authors.lastname: Boyle
authors.affiliation: Department of Radiation Oncology, Baylor Scott and White Health, Temple, Texas, USA.
authors.forename: Niloyjyoti
authors.initials: N
authors.lastname: Deb
authors.affiliation: Department of Radiation Oncology, Baylor Scott and White Health, Temple, Texas, USA.
authors.forename: Mehul
authors.initials: M
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008654:Mesothelioma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*
keywords: extra pleural pnemonectomy; intensity modulated radiation therapy; malignant pleural mesothelioma