Online citations, reference lists, and bibliographies.
← Back to Search

Influence Of Radiotherapy Technique And Dose On Patterns Of Failure For Mesothelioma Patients After Extrapleural Pneumonectomy.

A. Allen, Robert Den, J. Wong, D. Zurakowski, R. Soto, P. Jänne, L. Zellos, R. Bueno, D. Sugarbaker, E. Baldini
Published 2007 · Medicine

Cite This
Download PDF
Analyze on Scholarcy
PURPOSE Extrapleural pneumonectomy (EPP) is an effective treatment of malignant pleural mesothelioma. We compared the outcomes after moderate-dose hemithoracic radiotherapy (MDRT) and high-dose hemithoracic RT (HDRT) after EPP for malignant pleural mesothelioma. METHODS AND MATERIALS Between July 1994 and April 2004, 39 patients underwent EPP and adjuvant RT at Dana-Farber Cancer Institute/Brigham and Women's Hospital. Between 1994 and 2002, MDRT, including 30 Gy to the hemithorax, 40 Gy to the mediastinum, and boosts to positive margins or nodes to 54 Gy, was given, generally with concurrent chemotherapy. In 2003, HDRT to 54 Gy with a matched photon/electron technique was given, with sequential chemotherapy. RESULTS A total of 39 patients underwent RT after EPP. The median age was 59 years (range, 44-77). The histologic type was epithelial in 25 patients (64%) and mixed or sarcomatoid in 14 patients (36%). Of the 39 patients, 24 underwent MDRT and 15 (39%) HDRT. The median follow-up was 23 months (range, 6-71). The median overall survival was 19 months (95% confidence interval, 14-24). The median time to distant failure (DF) and local failure (LF) was 20 months (95% confidence interval, 14-26) and 26 months (95% confidence interval, 16-36), respectively. On univariate and multivariate analyses, only a mixed histologic type was predictive of inferior DF (p <0.006) and overall survival (p <0.004). The RT technique was not predictive of LF, DF, or overall survival. The LF rate was 50% (12 of 24) after MDRT and 27% (4 of 15) after HDRT (p = NS). Four patients who had undergone HDRT were alive and without evidence of disease at the last follow-up. CONCLUSIONS High-dose hemithoracic RT appears to limit in-field LF compared with MDRT. However, DF remains a significant challenge, with one-half of our patients experiencing DF.
This paper references
Intensity-modulated radiation therapy: a novel approach to the management of malignant pleural mesothelioma.
A. Ahamad (2003)
Node status has prognostic significance in the multimodality therapy of diffuse, malignant mesothelioma.
D. Sugarbaker (1993)
Malignant pleural mesothelioma
H. Kindler (2000)
A randomized trial of postoperative adjuvant therapy in patients with completely resected stage II or IIIA non-small-cell lung cancer. Eastern Cooperative Oncology Group.
S. Keller (2000)
Prevention, early detection, and management of complications after 328 consecutive extrapleural pneumonectomies.
D. Sugarbaker (2004)
Patterns of failure after trimodality therapy for malignant pleural mesothelioma.
E. Baldini (1997)
Tolerance of normal tissue to therapeutic irradiation.
B. Emami (1991)
The role of extrapleural pneumonectomy in malignant pleural mesothelioma. A Lung Cancer Study Group trial.
V. Rusch (1991)
Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma.
N. Vogelzang (2003)
Nonparametric Estimation from Incomplete Observations
E. L. Kaplan (1958)
Promising Early Local Control of Malignant Pleural Mesothelioma Following Postoperative Intensity Modulated Radiotherapy (IMRT) to the Chest
A. Ahamad (2003)
Multicentre phase II study of gemcitabine and cisplatin in malignant pleural mesothelioma
J. van Haarst (2002)
Malignant mesothelioma of the pleural space.
S. Grondin (1999)
A multicentre phase II study of cisplatin and gemcitabine for malignant mesothelioma
A. Nowak (2002)
Hemithoracic radiation after extrapleural pneumonectomy for malignant pleural mesothelioma.
S. Yajnik (2003)
Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients.
D. Sugarbaker (1999)
A phase II trial of surgical resection and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma.
V. Rusch (2001)
The Statistical Analysis of Failure Time Data
John D. Kalbfleisch (1980)

This paper is referenced by
Induction chemotherapy vs post-operative adjuvant therapy for malignant pleural mesothelioma
G. Marulli (2017)
Treatment of malignant pleural mesothelioma: current status and future directions
Paolo Andrea Zucali (2011)
Clinical indications and results after chest wall resection for recurrent mesothelioma.
B. Burt (2013)
Failure patterns after hemithoracic pleural intensity modulated radiation therapy for malignant pleural mesothelioma.
A. Rimner (2014)
Updated patterns of failure after multimodality therapy for malignant pleural mesothelioma.
E. Baldini (2015)
Mesothelioma and Thymic Tumors
Fred Wu (2010)
Chapter 46 – Uncommon Thoracic Tumors
J. Zeng (2016)
Intérêt de la tomothérapie après pleuro-pneumonectomie extrapleurale dans le mésothéliome pleural malin : premiers résultats cliniques
P. Giraud (2011)
Uncommon Thoracic Tumors
R. Rengan (2011)
Mesothelioma and Thymic Tumors
Michael Arnold Wahl (2018)
Intensity-Modulated Radiotherapy After Extrapleural Pneumonectomy in the Combined-Modality Treatment of Malignant Pleural Mesothelioma
A. Chi (2011)
Role of new radiation techniques in the treatment of pleural mesothelioma
M. Amichetti (2013)
British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma
I. Woolhouse (2018)
Radiation therapy options for malignant pleural mesothelioma.
E. Baldini (2009)
Impact of intensity-modulated radiation therapy on outcomes for malignant pleural mesothelioma treated with trimodality therapy
E. Murphy (2014)
PET-guided dose escalation tomotherapy in malignant pleural mesothelioma
Andrei Fodor (2011)
Surgery and Multimodality Treatment in Malignant Pleural Mesothelioma
Federico Rea (2019)
Malignant pleural mesothelioma.
A. Tsao (2009)
Chemotherapy and radiotherapy for mesothelioma.
Xavier Dhalluin (2011)
Surgery for malignant pleural mesothelioma.
D. Rice (2009)
Prevention of malignant seeding at drain sites after invasive procedures (surgery and/or thoracoscopy) by hypofractionated radiotherapy in patients with pleural mesothelioma
M. Di Salvo (2008)
What is the role of radiotherapy in malignant pleural mesothelioma?
A. Price (2011)
Surgical therapy of mesothelioma.
D. Rice (2011)
Malignantpleuralmesothelioma: currenttreatmentsandemerging drugs
Carmen Belli (2009)
Prolonged post-recurrence survival following pleurectomy/decortication for malignant pleural mesothelioma.
Yuichiro Kai (2019)
The Third Italian Consensus Conference for Malignant Pleural Mesothelioma: State of the art and recommendations.
S. Novello (2016)
Adjuvant intensity-modulated proton therapy in malignant pleural mesothelioma
S. Lorentini (2011)
Intensity-Modulated Radiation Therapy with Simultaneous Integrated Boost in Unresected Left-Sided Pleural Mesothelioma: A Case Report
S. Cilla (2010)
Mesothelioma at era of helical tomotherapy: results of two institutions in combining chemotherapy, surgery and radiotherapy.
A. Sylvestre (2011)
A Systematic Review of Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma
C. Cao (2010)
Long-term survival after lung-sparing total pleurectomy for locally advanced (International Mesothelioma Interest Group Stage T3-T4) non-sarcomatoid malignant pleural mesothelioma.
A. Nakas (2012)
Malignant mesothelioma
A. Moore (2008)
See more
Semantic Scholar Logo Some data provided by SemanticScholar