Open AccessRole of new radiation techniques in the treatment of pleural mesothelioma
Author(s) -
Amichetti Maurizio,
Lorentini Stefano,
Tonoli Sandro,
Magrini Stefano Maria
Publication year - 2013
Publication title -
thoracic cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.823
H-Index - 28
eISSN - 1759-7714
pISSN - 1759-7706
DOI - 10.1111/1759-7714.12008
Subject(s) - medicine , decortication , pleurectomy , extrapleural pneumonectomy , mesothelioma , radiation therapy , lung , pneumonectomy , pleural cavity , radiology , surgery , peritoneal mesothelioma , pathology
Malignant pleural mesothelioma ( MPM ) is an aggressive neoplasm arising from the surface serosal cells of the pleural cavity. Surgery remains the main therapeutic standard in the treatment of MPM with the goal of complete gross cytoreduction of the tumor. Because MPM is a diffuse disease affecting the entire mesothelial lining of the hemithorax, surgery alone can rarely achieve adequate tumor‐free resection margins. The surgical choices are pleurectomy/decortication ( P/D ) or extrapleural pneumonectomy ( EPP ). Radiotherapy ( RT ) is usually applied postoperatively with the aim to improve local control. However, the efficacy of RT is limited by the large volume of the target to be irradiated (tumor and pleural cavity) and the radiosensitivity of the nearby organs (heart, liver, lung, spinal cord, and esophagus). These factors have historically limited the effective radiation doses that can be given to the patient. There is no role for radical RT alone, but the role of RT as part of multimodality therapy is discussed. After EPP adjuvant RT to the entire hemithorax can reduce the recurrence rate and is well tolerated if strict limits to the dose to contralateral lung are applied: the V 20 and V 5 (the percent volume of the lung receiving more than 20 Gy and 5 Gy of radiation) correlate with increased lung toxicity. The use of modern sophisticated techniques allows good target coverage, more conformal high dose delivery, and clinically relevant normal tissue sparing.