Hemithoracic radiation therapy after extrapleural pneumonectomy for malignant pleural mesothelioma: Applicable to all and by all?

Our plain-English summary of Hemithoracic radiation therapy after extrapleural pneumonectomy for malignant pleural mesothelioma: Applicable to all and by all?, by R. Haas, P. Baas (Journal of Medical Imaging and Radiation Oncology, 2015).

The study

• Authors: R. Haas, P. Baas
• Journal: Journal of Medical Imaging and Radiation Oncology
• Published: 2015;59(3):353-4
• Type of article: Editorial, Comment
• Read it: PubMed · Publisher

In plain English

This article was an editorial, not a research study. Its two authors were from The Netherlands Cancer Institute. It commented on a study by Bece and colleagues, published in the same journal issue, of radiation therapy to one side of the chest after extrapleural pneumonectomy (surgical removal of a lung and its lining) for malignant pleural mesothelioma. The authors summarized that study. About five eligible patients were enrolled per year. Patients received 45–54 Gy by a 3D conformal technique (n = 31) or a nine-field IMRT technique (n = 18), and nine also received a focal boost of 5.4–12 Gy. Grade 3 side effects were limited to skin (8%), nausea (6%) and oesophagitis (2%). Late side effects were mainly liver-related, with a trend in favor of IMRT (50% vs 10%; P = 0.087), which the authors said could be explained by a time bias. At 18-month follow-up the local recurrence rate was 18.4%. The authors wrote that preventive irradiation of procedure scars is far from proven. They concluded that this treatment is feasible only by a dedicated team for highly selected patients, within well-designed prospective clinical trials.

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: editorial commenting on another study (Bece et al.) in the same journal issue
• Who was studied: No population of its own. The editorial discussed the Bece et al. study of patients with malignant pleural mesothelioma treated at an Australian institution, which enrolled about five eligible patients per year.
• Exposure: No asbestos exposure was discussed. The subject was hemithoracic radiation therapy after extrapleural pneumonectomy, given after neoadjuvant pemetrexed and platinum chemotherapy, for malignant pleural mesothelioma.
• Main results:
  • As summarized by the editorial, patients in the Bece et al. study received 45–54 Gy in 25–30 fractions, by 3D conformal technique (n = 31) or later by nine-field IMRT (n = 18).
  • As summarized by the editorial, a minority of patients in the Bece et al. study (n = 9) also received a focal boost of 5.4–12 Gy.
  • As summarized by the editorial, grade 3 toxicities in the Bece et al. study were limited to skin (8%), nausea (6%) and oesophagitis (2%).
  • As summarized by the editorial, late toxicity in the Bece et al. study was mainly liver-related, with a trend in favor of IMRT (50% vs 10%; P = 0.087). The editorial authors said this could be explained by a time bias.
  • As summarized by the editorial, the local recurrence rate in the Bece et al. study was 18.4% at 18-month follow-up.
  • The editorial authors stated that preventive irradiation of scars after thoracoscopy or drainage procedures, intended to reduce seeding metastases, is far from proven.
• The authors' conclusion: The authors concluded that locally aggressive management of malignant pleural mesothelioma is feasible only when performed by a dedicated team for highly selected patients. They said it should be done only by an experienced team within a well-designed prospective clinical trial with a standard control arm and proper quality-of-life testing.

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), Pleural Mesothelioma.

Related studies

• Patterns of failure, toxicity, and survival after extrapleural pneumonectomy and hemithoracic intensity-modulated radiation therapy for malignant pleural mesothelioma — D.R. Gomez, D.S. Hong, et al. (2013)
• Hemithoracic radiation therapy after extrapleural pneumonectomy for malignant pleural mesothelioma: Toxicity and outcomes at an Australian institution — A. Bece, M.M. Tin, et al. (2015)
• Impact of induction therapy on postoperative outcome after extrapleural pneumonectomy for malignant pleural mesothelioma: does induction-accelerated hemithoracic radiation increase the surgical risk? — P. Mordant, K. McRae, et al. (2016)
• Accelerated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma — M. de Perrot, R. Feld, et al. (2016)
• Trimodality strategy for treating malignant pleural mesothelioma: results of a feasibility study of induction pemetrexed plus cisplatin followed by extrapleural pneumonectomy and postoperative hemithoracic radiation (Japan Mesothelioma Interest Group 0601 Trial) — S. Hasegawa, M. Okada, et al. (2016)
• High-dose-rate surface brachytherapy to boost elongated, curvilinear incisional scars after extrapleural pneumonectomy for malignant pleural mesothelioma treated with adjuvant intensity-modulated radiation therapy — L.A. Doyle, T.N. Showalter, et al. (2010)

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