Document Detail

Tomotherapy after pleurectomy/decortication or biopsy for malignant pleural mesothelioma allows the delivery of high dose of radiation in patients with intact lung.
MedLine Citation:
PMID:  23154558     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: This study aimed to assess the safety of high doses of radiation delivered with tomotherapy to the intact lung after radical pleurectomy/decortication or biopsy for malignant pleural mesothelioma (MPM).
METHODS: Twenty-eight patients were enrolled in this prospective study and underwent adjuvant or definitive tomotherapy after radical pleurectomy/decortication (n = 20) or pleural biopsy (n = 8) for MPM. The dose prescribed to the planning target volume, defined as the entire hemithorax, including chest-wall incisions and drain sites and excluding the intact lung, was 50 Gy delivered in 25 fractions. All patients underwent fluorodeoxyglucose-positron emission tomography for staging after surgery. Any fluorodeoxyglucose-avid areas or regions of particular concern for residual disease were given a simultaneous boost of radiotherapy to 60 Gy. Specific lung dosimetric parameters were reported. Toxicity was graded using the modified Common Toxicity Criteria version 3.0.
RESULTS: The median follow-up was of 19 months (range, 6-29 months). Five patients (17.8%) experienced severe respiratory symptoms corresponding to grade 2 pneumonitis in three cases, and grade 3 pneumonitis in two cases. No fatal respiratory toxicity was reported. Controlateral lung V5 was strongly correlated with the risk of pneumonitis. Patients who developed grade 2 and 3 pneumonitis had a higher controlateral lung V5 (mean V5=32%) than those without pneumonitis (mean V5=17%) (p=0.002). Other two grade 3 toxicities were registered: one severe pain to the chest wall, and one severe thrombocytopenia.
CONCLUSIONS: Tomotherapy allows the safe delivery of high dose of radiation to the hemithorax of MPM patients with intact lung.
Emilio Minatel; Marco Trovo; Jerry Polesel; Imad Abu Rumeileh; Tania Baresic; Alessandra Bearz; Alessandro Del Conte; Giovanni Franchin; Carlo Gobitti; Annalisa Drigo; Andrea Dassie; Vittore Pagan; Mauro G Trovo
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer     Volume:  7     ISSN:  1556-1380     ISO Abbreviation:  J Thorac Oncol     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-16     Completed Date:  2013-05-07     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  101274235     Medline TA:  J Thorac Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1862-6     Citation Subset:  IM    
Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Italy.
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MeSH Terms
Aged, 80 and over
Fluorodeoxyglucose F18 / diagnostic use
Follow-Up Studies
Lung / radiation effects*,  surgery
Mesothelioma / pathology,  radiotherapy*,  surgery
Middle Aged
Neoplasm Staging
Pleural Neoplasms / pathology,  radiotherapy*,  surgery
Positron-Emission Tomography
Prospective Studies
Radiotherapy Dosage*
Radiotherapy, Intensity-Modulated*
Survival Rate
Reg. No./Substance:
63503-12-8/Fluorodeoxyglucose F18
Comment In:
J Thorac Oncol. 2013 May;8(5):e50-1   [PMID:  23584308 ]
J Thorac Oncol. 2013 May;8(5):e50   [PMID:  23584307 ]

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