Open AccessIntensity‐modulated radiotherapy is a safe and effective treatment for localized malignant pleural mesothelioma
Author(s) -
Simon Michael,
Shochat Tzippy,
Peled Nir,
Zer Alona,
Kramer Mordechai R.,
Eldan Orit,
Saute Milton,
Dudnik Elizabeth R.,
Allen Aaron M.
Publication year - 2018
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 - 10.1111/1759-7714.12860
Subject(s) - medicine , extrapleural pneumonectomy , radiation therapy , mesothelioma , pleural disease , pneumonitis , surgery , chemotherapy , incidence (geometry) , medical record , radiology , pneumonectomy , lung , respiratory disease , pathology , physics , optics
Background Malignant pleural mesothelioma (MPM) is a rare disease and management of localized disease is controversial. Radiotherapy has been shown to be useful after extrapleural pneumonectomy (EPP), as well as with less aggressive surgery. As no reports of the treatment of this disease have ever been published from Israel, we report our experience with MPM and intensity‐modulated radiotherapy (IMRT). Methods The complete medical records of patients treated for MPM at the Rabin Medical Center from 1 August 2007 to 31 March 2016 were reviewed. Twenty‐seven patients were treated with IMRT, either post‐EPP or without EPP. Patients received 54 Gy in 2 Gy fractions using the restricted field IMRT technique. Chemotherapy was administered sequentially in 26% of patients. Patients were followed up from the date of diagnosis to death or treatment failure. Results Seventy‐eight percent of patients had the epithelioid subtype. Nearly all patients were male (85%) and 90% of non‐surgical patients were administered chemotherapy compared to 56% of post‐EPP patients. All patients completed therapy and only 16% had grade 1–2 radiation pneumonitis, with no incidence of grade 3 or higher. The median follow‐up was 22 months and the mean overall survival was 34.9 months. The mean time to progression following radiation therapy was 26.7 months. The mean time to local and distant failure was 19 and 16 months, respectively. Conclusions IMRT for localized pleural mesothelioma is a tolerable and effective therapy both post‐EPP or without surgery. These results suggest that future investigation in this area is required.