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.

中文翻译：

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局部晚期恶性胸膜间皮瘤保肺手术后螺旋断层放疗的安全性和有效性

目的

评估放射治疗 (RT) 联合螺旋断层放射治疗 (HT) 在治疗未接受手术或保留肺手术的局部晚期恶性胸膜间皮瘤 (MPM) 中的价值。

方法

对连续未接受胸膜外肺切除术并接受调强 (IM) HT 的 MPM 病例的局部控制、远处控制、无进展生存期 (PFS) 和总生存期 (OS) 进行回顾性评估。通过单变量和多变量分析来分析年龄、全身治疗、放疗剂量和复发模式的影响。作为次要终点，评估了报告的毒性。

结果

总共确定了 34 例接受 IMHT 的局部 MPM 病例，其中 31 例患者可获得随访数据。26.7% 的患者出现 3 级副作用，没有观察到 4 级或 5 级事件。中位 PFS 为 19 个月。中位 OS 为 20 个月，1 年和 2 年 OS 率分别为 86.2% 和 41.4%。接受辅助化疗的患者的 OS 明显优于 ( p  = 0.008)。

结论

保留肺手术后局部晚期 MPM 的 IMHT 是安全可行的，可实现令人满意的局部控制和生存。辅助化疗显着改善 OS。纳入现代 RT 技术作为三模式治疗组成部分的随机临床试验有必要为局部晚期 MPM 建立基于证据的护理模式标准。