Adjuvant radiotherapy after extrapleural pneumonectomy for mesothelioma. Prospective analysis of a multi-institutional series

Our plain-English summary of Adjuvant radiotherapy after extrapleural pneumonectomy for mesothelioma. Prospective analysis of a multi-institutional series, by S. Tonoli, P. Vitali, V. Scotti, et al (Radiotherapy and Oncology, 2011).

The study

• Authors: S. Tonoli, P. Vitali, V. Scotti, F. Bertoni, L. Spiazzi, B. Ghedi, F.B. Buonamici, L. Marrazzo, G. Guidi, I. Meattini, P. Bastiani, M. Amichetti, M. Schwarz, S.M. Magrini
• Journal: Radiotherapy and Oncology
• Published: 2011;101(2):311-5
• Cited by: 36 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background And Purpose: To evaluate survival, locoregional control and toxicity in a series of 56 mesothelioma patients treated from May 2005 to May 2010 with post-operative radiotherapy after extrapleural pneumonectomy (EPP) in three Italian Institutions (Brescia, Florence, and Modena).

Material And Methods: Fifty-six patients treated with adjuvant radiotherapy (RT) after EPP were analyzed. Four patients were treated with 3DCRT, 50 with IMRT and two with helical tomotherapy. Forty-five to 50 Gy in 25 fractions were given to the affected hemithorax and to ipsilateral mediastinum, with a simultaneous integrated boost to the sites of microscopically involved margins up to 60 Gy in 20/56 cases.

Results: Three year locoregional control (LRC), distant metastasis free (DMF), disease free (DF), disease specific (DSS) and overall survival (OS) rates are 90%, 66%, 57%, 62%, and 60%, respectively.

Conclusion: Postoperative RT with modern techniques is an effective method to obtain excellent local control and cure rates in mesothelioma patients submitted to EPP.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

In plain English

This study described 56 people with malignant pleural mesothelioma given radiotherapy after extrapleural pneumonectomy at three Italian centers (Brescia 48, Florence 6, Modena 2) from May 2005 to May 2010. The authors called it a non-randomized, observational study of selected patients. Most received intensity-modulated radiotherapy (IMRT), at 45 to 50 Gy in 25 fractions. In 20 patients, margin areas with microscopic tumor got a boost of up to 60 Gy. The article did not report asbestos exposure. Median follow-up was 20 months from surgery. At three years, locoregional control was 90% (plus or minus 5; 13 patients at risk), disease-free survival 57% (plus or minus 9; 10 at risk) and overall survival 60% (plus or minus 7; 14 at risk); median survival was 46.9 months. Eighteen patients had a recurrence; in 13 the first recurrence was distant. Two patients died of conditions possibly related to radiotherapy. One had liver veno-occlusive disease; the other had constrictive pericarditis, of unknown relation to radiotherapy. The authors concluded that, since about 80% had stage III or IV disease, the results seemed encouraging.

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: Non-randomized, observational series of patients treated consecutively with post-operative radiotherapy after extrapleural pneumonectomy (the title calls it a prospective analysis of a multi-institutional series)
• Who was studied: 56 patients with malignant pleural mesothelioma treated consecutively with post-operative radiotherapy after extrapleural pneumonectomy at three Italian institutions (Brescia 48, Florence 6, Modena 2), May 2005 to May 2010
• Exposure: The exposure studied was treatment, not asbestos: adjuvant radiotherapy after extrapleural pneumonectomy. Four patients had 3DCRT, 50 had IMRT and 2 had helical tomotherapy. Doses were 45 to 50 Gy in 25 fractions to the affected hemithorax and ipsilateral mediastinum, with a boost of up to 60 Gy to microscopically involved margins in 20 of 56 cases. Asbestos exposure was not reported.
• Main results:
  • All 56 patients, at 3 years: locoregional control 90%, distant metastasis-free survival 66%, disease-free survival 57%, disease-specific survival 62%, overall survival 60%
  • Table 4, locoregional control: 93 plus or minus 4% at 1 year (35 at risk), 90 plus or minus 5% at 2 years (20 at risk), 90 plus or minus 5% at 3 years (13 at risk)
  • Table 4, overall survival: 79 plus or minus 6% at 1 year (38 at risk), 64 plus or minus 7% at 2 years (22 at risk), 60 plus or minus 7% at 3 years (14 at risk)
  • Table 4, disease-free survival: 78 plus or minus 6% at 1 year (32 at risk), 70 plus or minus 7% at 2 years (18 at risk), 57 plus or minus 9% at 3 years (10 at risk)
  • Median follow-up was 20 months from surgery (mean 26.2, range 5 to 74 months)
  • In this series, median survival was 46.9 months; 2-year survival was 64% and 3-year survival 60%
  • No difference in locoregional control, local relapse-free survival, disease-free survival or overall survival was detected between groups treated with different doses
  • The authors could not demonstrate any influence of chemotherapy (before surgery, after surgery or during surgery) on survival
  • Eighteen patients had a recurrence during follow-up (the article gives this as 29.5%)
  • First site of recurrence: local in 2, nodal in 3, distant in 13 (6 lung/pleural, 6 peritoneum, 1 both)
  • Two patients died of morbidity possibly related to radiotherapy
  • One patient died of veno-occlusive liver disease 8 months after the end of radiotherapy
  • A second patient died of constrictive pericarditis 3 years after treatment; it is not known whether this was related to radiotherapy
  • None of the treated patients had pulmonary complications or a decline in respiratory function parameters
• The authors' conclusion: The authors concluded that, considering about 80% of treated patients had stage III/IV disease at pathologic examination, the results seemed encouraging
• Limitations the authors state:
  • The patients were a selected group
  • The study was not randomized and was observational
  • Target coverage with IMRT, particularly in the costophrenic recess, could be further improved

Topics

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

Medical terms in this study, explained in our Lexicon: Extrapleural Pneumonectomy (EPP), Mesothelioma, Multi-Institutional Series, Hemithorax, Mediastinum, Metastasis, Overall Survival.

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• Staging of patients after extrapleural pneumonectomy for malignant pleural mesothelioma--institutional review and current update — C. Cao, S.K. Krog Andvik, et al. (2011)
• Hemithoracic intensity-modulated radiotherapy using helical tomotherapy for patients after extrapleural pneumonectomy for malignant pleural mesothelioma — T. Ebara, H. Kawamura, et al. (2012)
• Second surgery for recurrence of malignant pleural mesothelioma after extrapleural pneumonectomy — L. Politi, G. Borzellino (2010)

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