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Intensity modulated radiation therapy after extra‐pleural pneumonectomy for malignant pleural mesothelioma is feasible without fatal pulmonary toxicity and provides good survival
Author(s) -
Jhavar Sameer,
Pruszynski Jessica,
Gowan Alan,
Boyle Teresa,
Deb Niloyjyoti,
Patel Mehul
Publication year - 2018
Publication title -
asia‐pacific journal of clinical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 29
eISSN - 1743-7563
pISSN - 1743-7555
DOI - 10.1111/ajco.12680
Subject(s) - medicine , extrapleural pneumonectomy , mesothelioma , radiation therapy , pulmonary toxicity , lung cancer , surgery , esophagitis , lung , oncology , pneumonectomy , pathology , disease , reflux
Aim 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. Conclusion Intensity‐modulated radiation therapy following EPP for MPM resulted in RFS and OS comparable to the published literature without significant toxicity.