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• W2758004767 abstract "In the treatment of malignant pleural mesothelioma (MPM), there is evidence to support the use of pleurectomy/decortication (P/D) for surgical resection. This presents a unique challenge to the radiation oncologist to treat the pleura and chest wall while minimizing radiation dose to the underlying lung. Treatment with Intensity-Modulated Pleural Radiation Therapy (IMPRINT) has previously been shown to be efficacious and safe (Rimner et al. J Clin Oncol 2016). It has been shown that Volumetric Modulated Arc Therapy (VMAT) provides superior sparing of critical organs with reduced monitor units (MU) and delivery time when compared to IMRT, while adequately covering the planning target volume (PTV) (Dumane et al. Applied Rad Onc 2016). In this study we evaluated the safety and efficacy of treating this population with IMPRINT using VMAT at our institution. We identified 40 patients at our institution who underwent P/D followed by adjuvant radiation therapy (RT) from 2010-2016. VMAT typically included a minimum of 2 complementary co-planar arcs to cover the PTV. Electronic Medical Records were reviewed for toxicity, recurrence and survival data. Statistical analysis was performed using the Life Table method. The cohort included 26 men and 14 women. 73% had epithelial histology, 3% - sarcomatoid, 23% - mixed and 3% - pleomorphic/anaplastic. The median follow up time was 14.5 months (range 3-42 months). The median radiation dose delivered was 45 Gy (range, 30 – 54 Gy). Chemotherapy (pemetrexed/platinum doublet) consisted of: none (33%), induction (20%), adjuvant (23%). 15% of patients received chemotherapy following surgery but prior to the initiation of RT. The majority of patients (60%) began RT within one month following surgical resection. 70% of patients had an R1 resection and 30% had an R2 resection prior to radiation treatment. The most common adverse effect was fatigue: 80%, 12.5% and 7.5% of patients reported grade 1, 2 or 3 fatigue respectively. 62.5%, 35% and 2.5% of patients reported grade 1, 2 or 3 nausea respectively. Six patients (15%) developed grade 2 or 3 pneumonitis and 1 patient (3%) had grade 5 pneumonitis. 2 patients (5%) developed grade 2 or 3 pericarditis. The 1- and 2-year actuarial rates of overall survival were 62.5% and 17.5%, respectively. The 1- and 2- year actuarial rates of recurrence-free survival were 52.5% and 12.5%, respectively. This is the largest analysis to date of treatment outcomes with adjuvant radiation therapy with IMPRINT using VMAT following pleurectomy/decortication. VMAT provides a reduction in treatment time and improves sparing of critical structures. Our data demonstrate that treatment with this technique is well tolerated and survival is comparable with previous reports." @default.
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• W2758004767 date "2017-10-01" @default.
• W2758004767 modified "2023-10-18" @default.
• W2758004767 title "Safety and Efficacy of Treatment of Malignant Pleural Mesothelioma with Imprint Radiation Therapy Using VMAT Following Pleurectomy/Decortication" @default.
• W2758004767 doi "https://doi.org/10.1016/j.ijrobp.2017.06.1793" @default.
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