A reply to "managing oligoprogressive malignant pleural mesothelioma with stereotactic body radiation therapy"

Our plain-English summary of A reply to "managing oligoprogressive malignant pleural mesothelioma with stereotactic body radiation therapy", by G.L. Ceresoli, P. Ghirardelli, D. Franceschini, et al (Lung Cancer, 2021).

The study

• Authors: G.L. Ceresoli, P. Ghirardelli, D. Franceschini, M. Scorsetti, V. Vavassori
• Journal: Lung Cancer
• Published: 2021;157:165-166
• Type of article: Letter, Comment
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This was a letter to the editor, not a new study. The authors replied to a letter by Barsky and colleagues about stereotactic body radiation therapy (SBRT) for oligo-progressive malignant pleural mesothelioma, meaning disease that progressed at a limited number of sites after earlier treatment. The authors' own earlier study of 37 patients given focal radiotherapy had reported 76% local control at one year. For this letter, they re-examined 9 of those patients who were treated after one line of chemotherapy and extended surgery. All 9 had epithelioid histology. Their age, sex and performance status did not differ from the whole group. In the subgroup, the median treated volume was 50 cubic centimetres, against 151 in the whole group. The median biologically effective dose was 117 Gy, against 90 Gy. Local control in the subgroup was 100% at 6 months and 83% at one year, against 84% and 76% in the whole group. The authors concluded that they supported high-dose SBRT and stressed careful selection of patients progressing after first-line therapy. They noted that all reported series were small and retrospective. The letter does not discuss asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Letter to the editor (reply), including a re-review of a subgroup from the authors' earlier retrospective series
• Who was studied: Patients with oligo-progressive malignant pleural mesothelioma from the authors' earlier study (37 patients overall), with a subgroup of 9 treated with focal radiotherapy after 1 line of chemotherapy and extended surgery. The letter does not state place or dates for these patients.
• Main results:
  • In the authors' earlier study, 1-year local control was 76%. The letter credits 100% to the Barsky et al. series and 73.5% to the Schröder et al. series.
  • Age, sex and performance status in the subgroup of 9 did not differ from the whole study population.
  • All patients in the subgroup of 9 (100%) had epithelioid histology, compared with 33 of 37 (89%) in the overall group.
  • The subgroup of 9 had smaller planning target volumes (median 50 cm3, IQR 25 to 81, versus 151 cm3, IQR 50 to 480, in the overall group of 37). They were treated with higher biologically effective doses (median 117 Gy, IQR 90 to 150, versus 90 Gy, IQR 67 to 137). The authors describe the smaller volumes as significant; no p-value is printed.
  • Local control in the subgroup of 9 was 100% at 6 months and 83% at 1 year, compared with 84% and 76% in the overall group of 37.
• The authors' conclusion: The authors agreed with Barsky and colleagues in advocating high biologically effective dose SBRT for oligo-progressive malignant pleural mesothelioma. They stressed proper patient selection focused on patients progressing after first-line medical or multimodal therapy.
• Limitations the authors state:
  • In all the reported series, including the authors' own, patients were identified retrospectively from small single- or multi-institution series spanning 9 to 13 years.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Stereotactic Body Radiation Therapy (SBRT).

Related studies

• Managing oligoprogressive malignant pleural mesothelioma with stereotactic body radiation therapy — A.R. Barsky, N. Yegya-Raman, et al. (2021)
• Cyberknife radiosurgery for focal paravertebral recurrence after radical pleurectomy/decortication in malignant pleural mesothelioma — L. Lang-Lazdunski, S. Barrington, et al. (2012)
• Reply to: Oncolytic Viral Therapy for Malignant Pleural Mesothelioma — D. Jean, T. Delaunay, et al. (2020)
• Dose estimation for internal organs during boron neutron capture therapy for body-trunk tumors — Y. Sakurai, H. Tanaka, et al. (2014)
• Radiation therapy in the management of patients with mesothelioma — W. Gordon, K.H. Antman, et al. (1982)
• A feasibility study evaluating Surgery for Mesothelioma After Radiation Therapy: the "SMART" approach for resectable malignant pleural mesothelioma — B.C. Cho, R. Feld, et al. (2014)

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