Cyberknife radiosurgery for focal paravertebral recurrence after radical pleurectomy/decortication in malignant pleural mesothelioma

Our plain-English summary of Cyberknife radiosurgery for focal paravertebral recurrence after radical pleurectomy/decortication in malignant pleural mesothelioma, by L. Lang-Lazdunski, S. Barrington, A. Bille, et al (European Journal of Cardio-thoracic Surgery, 2012).

The study

• Authors: L. Lang-Lazdunski, S. Barrington, A. Bille, P.Y. Bondiau
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 2012;41(6):1393-4
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We present a case of malignant pleural mesothelioma with focal relapse in the Azygos arch region after radical pleurectomy/decortication and adjuvant chemotherapy. Tumour recurrence was successfully treated by Cyberknife radiosurgery (70 Gy in five fractions). Patient remains disease-free at 40 months without any other treatment.

In plain English

This is a case report of one patient. A 62-year-old man, a lifelong non-smoker who reported asbestos exposure in the 1960s, was diagnosed in 2007 with epithelioid malignant pleural mesothelioma. In August 2007 he had radical pleurectomy/decortication, which confirmed stage IB disease. This was followed by preventive radiotherapy to the surgical and drain sites and six cycles of pemetrexed and cisplatin chemotherapy. A PET-CT scan in June 2008 showed abnormal uptake near the azygos arch (SUVmax 7.3), which was treated as a localized relapse. In July 2008 he received Cyberknife radiosurgery, 70 Gy in five daily fractions. Three months later uptake had fallen to SUVmax 1.3. Later scans showed low-grade uptake (SUVmax 3.3) that the authors attributed to localized radiation pneumonitis. He had persistent right T4-T5 nerve pain, which the authors said could be a side effect of the radiotherapy. He was reported active and disease-free 40 months after radiosurgery. The authors concluded that Cyberknife is unlikely to suit most mesothelioma patients but may be an option for some with very limited, localized disease.

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: case report (one patient)
• Who was studied: One 62-year-old man, a life-long non-smoker, treated at Guy's and St Thomas' NHS Foundation Trust, London, from 2006 onward
• Exposure: Asbestos exposure in the 1960s as disclosed by the patient (fiber type, job and dose not stated). The treatment studied was Cyberknife radiosurgery, 70 Gy in five daily fractions, for relapse after radical pleurectomy/decortication and adjuvant chemotherapy.
• Main results:
  • Earlier CT in November 2006 showed pleural plaques and right pleural thickening.
  • Surgery in August 2007 confirmed malignant pleural mesothelioma, epithelioid subtype, stage IB.
  • PET-CT in June 2008, after surgery, prophylactic radiotherapy and chemotherapy, showed abnormal uptake around the azygos arch with SUVmax 7.3, considered a localized relapse.
  • The patient received Cyberknife radiosurgery, 70 Gy in five daily fractions, in July 2008.
  • PET-CT 3 months after radiosurgery showed very low-grade uptake (SUVmax 1.3).
  • PET-CT in July 2010 and January 2011 showed persistent low-grade uptake (SUVmax 3.3), interpreted as localized radiation pneumonitis.
  • The patient had persistent right T4-T5 neuralgia, which the authors said could be a side effect of the stereotactic radiotherapy.
  • The patient was reported active and disease-free 40 months after Cyberknife radiosurgery and more than 4 years after surgery.
• The authors' conclusion: The authors concluded that Cyberknife radiosurgery is unlikely to be adequate for most patients with malignant pleural mesothelioma, but may be a curative or palliative option for some patients with very limited, localized disease.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleurectomy/Decortication (P/D), Pleural Mesothelioma, Chemotherapy.

Related studies

• Clinical Outcomes With Recurrence After Pleurectomy/Decortication for Malignant Pleural Mesothelioma — A. Nakamura, T. Takuwa, et al. (2020)
• Pleurectomy/decortication, hyperthermic pleural lavage with povidone-iodine, prophylactic radiotherapy, and systemic chemotherapy in patients with malignant pleural mesothelioma: a 10-year experience — L. Lang-Lazdunski, A. Bille, et al. (2015)
• Patterns of disease progression on 18F-fluorodeoxyglucose positron emission tomography-computed tomography in patients with malignant pleural mesothelioma undergoing multimodality therapy with pleurectomy/decortication — A. Bille, S. Chicklore, et al. (2013)
• Radiofrequency Ablation Effectively Treated Focal Recurrence of Mesothelioma — A. Nakamura, T. Takuwa, et al. (2018)
• Pleurectomy/decortication, hyperthermic pleural lavage with povidone-iodine followed by adjuvant chemotherapy in patients with malignant pleural mesothelioma — L. Lang-Lazdunski, A. Bille, et al. (2011)
• Interim results of pleurectomy/decortication and intraoperative intrapleural hyperthermic cisplatin perfusion for patients with malignant pleural mesothelioma intolerable to extrapleural pneumonectomy — H. Ishibashi, M. Kobayashi, et al. (2015)

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