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• W2005980048 abstract "The treatment of MPM after pleurectomy/decortication (P/D) remains a therapeutic challenge with a recent report showing poor local control and long term survival with traditional mixed photon/electron treatment. IMRT has been associated with fatal radiation pneumonitis after pneumonectomy potentially due to excess dose to the contralateral lung, but has not been studied in patients who have not had pneumonectomy due to concerns of excess toxicity to the intact ipsilateral lung. This study reports on a novel technique to treat the hemithorax after P/D using IMRT, 18-FDG-PET registration and four dimensional radiation therapy. Seven patients with malignant pleural mesothelioma who underwent P/D were enrolled in a feasibility study. All patients were not candidates for extrapleural pneumonectomy due to impaired pulmonary function or extent of tumor. There were four right-sided tumors and all patients had epithelioid histology. A 18-FDG-PET was performed at the time of simulation in the treatment position and registered with the treatment planning CT to aid in tumor delineation. Patients were simulated with the Real-Time Position Management Gating System (Varian Medical Systems, Palo Alto, CA). The goal prescription dose was 5040 cGy, but it was adjusted to keep the normal tissue complication probability (NTCP) below a threshold of 25%. A typical treatment plan is presented in Figure 1. One patient was found to have metastatic disease at the time of simulation and not treated. The other six patients were treated to a median dose of 5040 cGy (range, 4500 cGy–5040 cGy). There were no cases of Grade 3 or worse pulmonary toxicity. In all patients, the planning target volume was modified due to information from the PET scan. Tumor and normal tissue motion was minimal in the diseased lung due to limited diaphragmatic excursion. In the six treated patients, there is a median follow-up of 8 months (range, 1–24 months). Two patients died of disease at 7 and 10 months, two patients are alive with recurrence at 21 and 24 months and two patients are alive with no evidence of disease at 1 and 7 months. Hemithoracic radiation therapy to an intact lung in malignant pleural mesothelioma is safe and feasible with the use of IMRT for treatment delivery and 18-FDG-PET for tumor delineation. Tumor motion control using a gating system is probably not helpful. This study demonstrates a novel treatment technique in patients with advanced aggressive disease with limited treatment options. We plan to open a Phase I/II study of this technique in patients with MPM who have had pleurectomy/decortication or unresectable disease." @default.
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• W2005980048 date "2007-11-01" @default.
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• W2005980048 title "Intensity Modulated Hemithoracic Radiation Therapy for Malignant Pleural Mesothelioma (MPM) after Pleurectomy/Decortication" @default.
• W2005980048 doi "https://doi.org/10.1016/j.ijrobp.2007.07.1706" @default.
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