Preliminary results of entire pleural intensity-modulated radiotherapy in a neoadjuvant setting for resectable malignant mesothelioma
- Author:
Ji Hyun HONG
1
;
Hyo Chun LEE
;
Kyu Hye CHOI
;
Seok Whan MOON
;
Kyung Soo KIM
;
Suk Hee HONG
;
Ju Young HONG
;
Yeon Sil KIM
;
Author Information
- Publication Type:Original Article
- Keywords: Mesothelioma; Neoadjuvant therapy; Radiotherapy; Combined modality therapy; Hemithoracic radiation
- MeSH: Chemotherapy, Adjuvant; Combined Modality Therapy; Drug Therapy; Follow-Up Studies; Humans; Male; Mesothelioma; Neoadjuvant Therapy; Neoplasm Metastasis; Pneumonectomy; Radiation Pneumonitis; Radiotherapy; Radiotherapy, Adjuvant; Radiotherapy, Intensity-Modulated; Recurrence
- From:Radiation Oncology Journal 2019;37(2):101-109
- CountryRepublic of Korea
- Language:English
- Abstract: PURPOSE: The purpose of this study is to evaluate the safety and efficacy of the multimodality treatment with neoadjuvant intensity-modulated radiotherapy (IMRT) for resectable clinical T1-3N0-1M0 malignant pleural mesothelioma (MPM). MATERIALS AND METHODS: A total of eleven patients who received neoadjuvant chemotherapy and radiotherapy between March 2016 and June 2018 were reviewed. Patients received 25 Gy in 5 fractions to entire ipsilateral hemithorax with helical tomotherapy. RESULTS: All of patients were men with a median age of 56 years. Epithelioid subtype was found in 10 patients. All patients received neoadjuvant chemotherapy with pemetrexed-cisplatin regimen. Ten patients (90.9%) completed 25 Gy/5 fractions and one (9.0%) completed 20 Gy/4 fractions of radiotherapy. IMRT was well tolerated with only one acute grade 3 radiation pneumonitis. Surgery was performed 1 week (median, 8 days; range, 1 to 15 days) after completing IMRT. Extrapleural pneumonectomy was performed in 4 patients (36.3%), extended pleurectomy/decortication in 2 (18.2%) and pleurectomy/decortications in 5 (63.6%). There was no grade 3+ surgical complication except two deaths after EPP in 1 month. Based on operative findings and pathologic staging, adjuvant chemotherapy was delivered in 7 patients (63.6%), and 2 (18.2%) were decided to add adjuvant radiotherapy. After a median follow-up of 14.6 months (range, 2.8 to 30 months), there were 3 local recurrence (33.3%) and 1 distant metastasis (11.1%). CONCLUSION: Neoadjuvant entire pleural IMRT can be delivered with a favorable radiation complication. An optimal strategy has to be made in resectable MPM patients who would benefit from neoadjuvant radiation and surgery. Further studies are needed to look at long-term outcomes.
