Helical tomotherapy for resected malignant pleural mesothelioma: dosimetric evaluation and toxicity

Our plain-English summary of Helical tomotherapy for resected malignant pleural mesothelioma: dosimetric evaluation and toxicity, by P. Giraud, A. Sylvestre, S. Zefkili, et al (Radiotherapy and Oncology, 2011).

The study

• Authors: P. Giraud, A. Sylvestre, S. Zefkili, A. Lisbona, P. Bonnette, F. Le Pimpec Barthes, E. Paris, C. Perigaud, A. Savignoni, M.A. Mahé
• Journal: Radiotherapy and Oncology
• Published: 2011;101(2):303-6
• Cited by: 22 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

This study evaluated adjuvant helical tomotherapy after extrapleural pneumonectomy ± neo-adjuvant chemotherapy in 24 patients with malignant pleural mesothelioma. Toxicity was judged acceptable despite 2 cases (8%) of suspected grade 5 pneumonitis. With a mean follow-up of 7 months, 5 patients had distant and 2 local and distant failure.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

In plain English

This retrospective study reviewed the medical records of 24 patients with malignant pleural mesothelioma (median age 61.5 years) who received helical tomotherapy, a type of radiotherapy, after surgery. They were treated at the Curie Institute in Paris and the René Gauducheau Cancer Center in Nantes, France, between August 2007 and December 2009. Extrapleural pneumonectomy (removal of the pleura and the whole lung on one side) was done in 23 patients. Thirteen had received platinum and pemetrexed chemotherapy before surgery. The main dose was 50 to 54 Gy, and all patients completed treatment. Within 6 months, four patients had severe breathing problems in which lung inflammation (pneumonitis) was suspected: two were grade 3 and two were grade 5 (fatal). The true cause of one death was not investigated. In the other, radiation pneumonitis could not be excluded. Over an average follow-up of 7 months, seven patients relapsed: five at distant sites only and two both locally and at distant sites. The authors judged toxicity acceptable. The article 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: Retrospective review of patient records at two cancer centers (treatment outcome study)
• Who was studied: 24 patients with malignant pleural mesothelioma (median age 61.5 years), 12 at each of two French centers (Curie Institute, Paris, and René Gauducheau Cancer Center, Nantes), treated between August 1, 2007 and December 1, 2009. Extrapleural pneumonectomy was done in 23 patients. 13 received neoadjuvant platinum and pemetrexed chemotherapy. Two thirds had stage III tumors, mostly epithelial type, and 5 had biphasic histologic type.
• Exposure: Not an asbestos exposure study. The exposure studied was postoperative (adjuvant) helical tomotherapy: 50–54 Gy to the main target volume (PTV1) at 2 Gy per fraction, with a 4–6 Gy boost (PTV2) in 8 patients and 46 Gy to a mediastinal volume (PTV3) in 9 patients. No asbestos fiber types or asbestos exposures are reported.
• Main results:
  • All 24 patients completed radiotherapy at the planned dose, with no treatment interruptions.
  • Among all patients, the median mean dose to PTV1 was 50 Gy (range 48.7–55.9 Gy).
  • Four patients had severe respiratory symptoms (two grade 3 and two grade 5) less than 6 months after treatment. Pneumonitis was suspected in all 4 cases.
  • One grade 5 patient spat up blood and died of acute pulmonary distress syndrome. The true cause of death was not investigated. This patient had a V20 of 22%, a V13 of 69% and a mean lung dose of 17 Gy.
  • The other grade 5 patient died of pneumonia and multiple pulmonary emboli. Radiation-induced pneumonitis could not be excluded.
  • Other side effects reported: one case of grade 3 esophagitis, one patient with grade 3 nausea with severe asthenia, 2 cases of grade 3 dermatitis, and no cardiac complications.
  • Neoadjuvant chemotherapy was associated with no increase in lung, esophageal or cardiac toxicity.
  • Seven patients relapsed, a median of 5 months (1.3–13.7 months) after radiotherapy. Five had distant relapse only and two had both local and distant relapse.
  • There were 4 deaths. Two patients with contralateral lung relapse died of respiratory failure, 0.8 and 10 months after relapse. Two patients died of pulmonary events that could have been related to lung toxicity, 29 and 50 days after the end of radiotherapy.
• The authors' conclusion: The authors judged toxicity acceptable despite 2 cases (8%) of suspected grade 5 pneumonitis. They concluded that helical tomotherapy is a useful tool to prevent local relapse in malignant pleural mesothelioma without causing unacceptable toxicity.
• Limitations the authors state:
  • For one of the two grade 5 cases, the true cause of death was not investigated.
  • The authors note that lung dose constraints and values changed over time as physicians and physicists became familiar with the technology.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Extrapleural Pneumonectomy (EPP), Chemotherapy, Pneumonitis.

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• Dosimetric Comparison Between Helical Tomotherapy and Volumetric Modulated Arc Therapy in Patients With Malignant Pleural Mesothelioma — T. Müdder, G.R. Sarria, et al. (2022)
• Dosimetric Correlates of Pulmonary Toxicity in Patients with Malignant Pleural Mesothelioma Receiving Radiation Therapy to the Intact Lungs — M.R. Thompson, V.A. Dumane, et al. (2019)
• Hemithoracic intensity-modulated radiotherapy using helical tomotherapy for patients after extrapleural pneumonectomy for malignant pleural mesothelioma — T. Ebara, H. Kawamura, et al. (2012)
• Tomotherapy PET-guided dose escalation: A dosimetric feasibility study for patients with malignant pleural mesothelioma — A. Maggio, C. Cutaia, et al. (2016)
• Tomotherapy after pleurectomy/decortication or biopsy for malignant pleural mesothelioma allows the delivery of high dose of radiation in patients with intact lung — E. Minatel, M. Trovo, et al. (2012)

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