Malignant pleural mesothelioma – Pleural cavity irradiation after decortication with helical tomotherapy

Abstract

Background

Malignant pleural mesothelioma (MPM) is a rare and aggressive disease that poses a treatment challenge in spite of recent technical developments. The aim of this retrospective analysis is to assess the feasibility of administering intensity-modulated radiotherapy (IMRT) to the pleural cavity using helical tomotherapy in patients who had undergone pleurectomy/decortication (P/D) and also the resulting toxicity levels.

Patients and methods

Ten patients who had MPM and had undergone P/D were treated with pleural cavity irradiation that included a median dose of 52.2[[ce:hsp sp="0.25"/]]Gy using helical tomotherapy. The median age of the patients was 53 years (31–74). In addition to clinical and diagnostic findings from regular follow-up examinations, we evaluated the dose distribution for other organs at risk to assess treatment in relation to toxicity, with special regard for the underlying intact lung.

Results

The mean lung dose on the treatment site was 32.8[[ce:hsp sp="0.25"/]]Gy (±6.8). The V_{20[[ce:hsp sp="0.25"/]]Gy} was 71.7% (±17.2). No treatment-related toxicity that exceeded grade III according to common toxicity criteria (CTC) was observed. Median progression-free survival (PFS) was 13 months with a median overall survival (OAS) of 19 months.

Conclusion

The findings of this analysis provide data indicating that sparing the underlying lung in patients with MPM after P/D is not only feasible with helical tomotherapy, but that this treatment also causes reasonably few side effects.