Radiat Oncol J.  2019 Jun;37(2):101-109. 10.3857/roj.2019.00150.

Preliminary results of entire pleural intensity-modulated radiotherapy in a neoadjuvant setting for resectable malignant mesothelioma

• Hong JH
• Lee HC
• Choi KH
• Moon SW
• Kim KS
• Hong SH
• Hong JY
• Kim YS
• Multidisciplinary Team of Lung Cancer in Seoul St. Mary's Hospital

• KMID: 2452570
• DOI: http://doi.org/10.3857/roj.2019.00150

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.

Keyword

Mesothelioma; Neoadjuvant therapy; Radiotherapy; Combined modality therapy; Hemithoracic radiation

MeSH Terms

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