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PET-guided Dose Escalation Tomotherapy In Malignant Pleural Mesothelioma

Andrei Fodor, C. Fiorino, I. Dell'Oca, S. Broggi, M. Pasetti, G. Cattaneo, L. Gianolli, R. Calandrino, Nadia Gisella Muzio
Published 2011 · Medicine

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PurposeTo test the feasibility of salvage radiotherapy using PET-guided helical tomotherapy in patients with progressive malignant pleural mesothelioma (MPM).Patients and MethodsA group of 12 consecutive MPM patients was treated with 56 Gy/25 fractions to the planning target volume (PTV); FDG-PET/CT simulation was always performed to include all positive lymph nodes and MPM infiltrations. Subsequently, a second group of 12 consecutive patients was treated with the same dose to the whole pleura adding a simultaneous integrated boost of 62.5 Gy to the FDG-PET/CT positive areas (BTV).ResultsGood dosimetric results were obtained in both groups. No grade 3 (RTOG/EORTC) acute or late toxicities were reported in the first group, while 3 cases of grade 3 late pneumonitis were registered in the second group: the duration of symptoms was 2–10 weeks. Median overall survival was 8 months (1.2–50.5 months) and 20 months (4.3–33.8 months) from the beginning of radiotherapy, for groups I and II, respectively (p = 0.19). A significant impact on local relapse from radiotherapy was seen (median time to local relapse: 8 vs 17 months; 1-year local relapse-free rate: 16% vs 81%, p = 0.003).ConclusionsThe results of this pilot study support the planning of a phase III study of combined sequential chemoradiotherapy with dose escalation to BTV in patients not able to undergo resection.ZusammenfassungZweckPrüfung der Machbarkeit von Salvage-Strahlentherapie mit der Hilfe PET-geführter helikaler Tomotherapie bei Patienten mit progredientem malignem Pleuramesotheliom (MPM).Patienten und MethodenDie erste Gruppe von 12 aufeinanderfolgenden MPM-Patienten wurde mit 56 Gy/25 Fraktionen im Planungszielvolumen behandelt. Eine FDG-PET/CT-Simulation wurde stets durchgeführt, um alle positiven Lymphknoten und MPM-Infiltrationen einzuschließen. Danach wurde eine zweite Gruppe von 12 aufeinanderfolgenden Patienten mit der gleichen Dosis auf der gesamten Pleura behandelt mit gleichzeitigem integriertem Boost von 62,5 Gy auf die FDG–PET/CT-positiven Bereiche (BTV).ErgebnisseGute dosimetrische Ergebnisse wurden in beiden Gruppen erzielt. In der ersten Gruppe wurde keine akute oder späte Grad-3-Toxizität (RTOG / EORTC) berichtet, während drei Fälle von später Grad-3-Pneumonitis in der zweiten Gruppe auftraten. Die Symptome hielten 2 bis 10 Wochen an. Das mediane Gesamtüberleben betrug 8 Monate (1,2–50,5 Monate) und 20 Monate (4,3–33,8 Monate) ab Therapiebeginn in Gruppe I und II (p = 0,19). Es wurde signifikanter Einfluss der Strahlentherapie auf Lokalrezidive beobachtet (mediane Zeit bis zum Lokalrezidiv: 8 vs 17 Monate; Rate 1-jähriger Lokalrezidivfreiheit: 16% vs 81%, p = 0,003).SchlussfolgerungenDie Ergebnisse dieser Pilotstudie sprechen für die Planung einer Phase-III-Studie der kombinierten sequentiellen Radiochemotherapie mit Dosiseskalation auf BTV bei inoperablen Patienten.
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