학술논문
Safety and efficacy of helical tomotherapy following lung-sparing surgery in locally advanced malignant pleural mesothelioma
Document Type
Original Paper
Author
Layer, Julian P.; Fischer, Pascal; Dejonckheere, Cas S.; Sarria, Gustavo R.; Mispelbaum, Rebekka; Hattenhauer, Tessa; Wiegreffe, Shari; Glasmacher, Andrea R.; Layer, Katharina; Nour, Youness; Caglayan, Lara; Grau, Franziska; Müdder, Thomas; Köksal, Mümtaz; Scafa, Davide; Giordano, Frank A.; Lopez-Pastorini, Alberto; Stoelben, Erich; Schmeel, Leonard Christopher; Leitzen, Christina
Source
Strahlentherapie und Onkologie: Journal of Radiation Oncology, Biology, Physics. 200(7):605-613
Subject
Language
English
ISSN
0179-7158
1439-099X
1439-099X
Abstract
Purpose: To assess the value of radiation therapy (RT) with helical tomotherapy (HT) in the management of locally advanced malignant pleural mesothelioma (MPM) receiving no or lung-sparing surgery.Methods: Consecutive MPM cases not undergoing extrapleural pneumonectomy and receiving intensity-modulated (IM) HT were retrospectively evaluated for local control, distant control, progression-free survival (PFS), and overall survival (OS). Impact of age, systemic treatment, RT dose, and recurrence patterns was analyzed by univariate and multivariate analysis. As a secondary endpoint, reported toxicity was assessed.Results: A total of 34 localized MPM cases undergoing IMHT were identified, of which follow-up data were available for 31 patients. Grade 3 side effects were experienced by 26.7% of patients and there were no grade 4 or 5 events observed. Median PFS was 19 months. Median OS was 20 months and the rates for 1‑ and 2‑year OS were 86.2 and 41.4%, respectively. OS was significantly superior for patients receiving adjuvant chemotherapy (p = 0.008).Conclusion: IMHT of locally advanced MPM after lung-sparing surgery is safe and feasible, resulting in satisfactory local control and survival. Adjuvant chemotherapy significantly improves OS. Randomized clinical trials incorporating modern RT techniques as a component of trimodal treatment are warranted to establish an evidence-based standard of care pattern for locally advanced MPM.