Mesothelioma at era of helical tomotherapy: results of two institutions in combining chemotherapy, surgery and radiotherapy

Our plain-English summary of Mesothelioma at era of helical tomotherapy: results of two institutions in combining chemotherapy, surgery and radiotherapy, by A. Sylvestre, M.A. Mahé, A. Lisbona, et al (Lung Cancer, 2011).

The study

• Authors: A. Sylvestre, M.A. Mahé, A. Lisbona, S. Zefkili, A. Savignoni, P. Bonnette, P. Barthes Fle, E. Paris, C. Perigaud, M. Yassa, P. Giraud
• Journal: Lung Cancer
• Published: 2011;74(3):486-91
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: There is a scarce clinical experience about adjuvant helical tomotherapy (HT) in patients affected by malignant pleural mesothelioma (MPM) even though it appears as a useful technique to treat complex volume as the pleural cavity, and seems to have better dose distribution than the "classic" intensity modulated radiotherapy (IMRT).

Methods And Materials: Twenty-four patients received adjuvant radiotherapy (RT) by HT from August 1st, 2007 to December 1st, 2009 at Curie Institute (Paris) and René Gauducheau Cancer Center (Nantes). Thirteen patients had neoadjuvant chemotherapy. Extrapleural pleuropneumonectomy (EPP) was done in 23 patients. Median dose to PTV was 50Gy [48.7-55.9Gy] (2Gy/fraction). Acute and long term toxicities, disease free survival (DFS), overall survival (OS) and relapses are presented.

Results: Average follow up after RT was 7 months. The disease was staged mostly as T2-T3, N1-N2. Nineteen patients had epithelial type histology. Most patients tolerated radiotherapy with grade 1-2 side effects: redness of the skin, light cough or dyspnea, fatigue, nausea and odynophagia, mild increase of the post-operative thoracic pain. Grade 3 pneumonitis was suspected in 2 patients. Two grade 5 pneumonitis were also suspected. Eleven patients had a follow up of more than 6 months and no long term side effects related with HT were noted. At 24 months, 51.8% of patients were free of disease. Thirty percent of patients relapsed, with 2 patients presenting local relapses. Two patients died from recurrence.

Conclusion: With limited follow up, HT has comparable toxicity to those observed with traditional IMRT. Higher radiation dose and good coverage results in excellent local control.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

In plain English

This was a retrospective review of 24 consecutive patients with malignant pleural mesothelioma. They received radiotherapy by helical tomotherapy after surgery between August 2007 and December 2009 at the Curie Institute (Paris) and René Gauducheau Cancer Center (Nantes) in France. Half had a documented history of asbestos exposure. Twenty-three had extrapleural pneumonectomy and 13 had chemotherapy before surgery. The median radiation dose to the main target was 50 Gy. Average follow-up after radiotherapy was 7 months. Most patients had grade 1–2 side effects. Grade 3 pneumonitis was suspected in two patients, and two others may have had fatal (grade 5) pneumonitis. At 24 months from diagnosis, an estimated 51.8% were free of disease (95% confidence interval 30.0 to 90.0). Thirty percent relapsed, and two patients died from relapsed cancer. The authors concluded that, with limited follow-up, the toxicity was comparable to traditional IMRT, and that higher dose and good coverage gave excellent local control. They noted the retrospective design, differences between the two centers, short follow-up, and that all included patients had survived surgery.

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 medical charts of consecutive patients treated at two cancer centers
• Who was studied: 24 consecutive patients with malignant pleural mesothelioma evaluated for adjuvant radiotherapy from August 1, 2007 to December 1, 2009 at the Curie Institute (Paris) and René Gauducheau Cancer Center (Nantes), France. Median age 61.5 years; 15 men and 9 women; 19 epithelial and 5 biphasic histology.
• Exposure: This is a treatment study, not a study of asbestos exposure. All patients received radiotherapy by helical tomotherapy after surgery. 23 had extrapleural pneumonectomy and 13 had chemotherapy (platin and pemetrexed) before surgery.
• Main results:
  • Half of the 24 patients (12) had a documented history of asbestos exposure
  • The median radiation dose prescribed to the main target volume was 50 Gy (range 48–54 Gy), at a median of 2 Gy per fraction
  • Average follow-up after the end of radiotherapy was 7 months
  • Most patients had grade 1–2 side effects from radiotherapy
  • Grade 3 pneumonitis was suspected in two patients. Two cases of grade 5 (fatal) pneumonitis may have occurred.
  • Among the 11 patients followed for more than 6 months, no long-term side effects related to radiotherapy were noted
  • At 24 months from diagnosis, 51.8% of patients were free of disease (95% confidence interval 30.0 to 90.0)
  • 30% of patients relapsed. The two local relapses occurred together with distant metastasis.
  • Two patients died from tumor relapse. Separately, two died of pulmonary events that could have been related to lung toxicity.
  • Median survival was estimated at 36 months
• The authors' conclusion: The authors concluded that, with limited follow-up, helical tomotherapy had toxicity comparable to that seen with traditional IMRT, and that higher radiation dose and good coverage resulted in excellent local control
• Limitations the authors state:
  • The chart review and analysis were done retrospectively
  • The two centers differed in use of chemotherapy, volumes irradiated and doses, which the authors say presents an inherent bias
  • Follow-up after radiotherapy was short
  • Selection bias: patients treated did not progress during chemotherapy and all survived surgery
  • Prospective studies and longer follow-up are needed to confirm the results

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Chemotherapy, Pleural Mesothelioma, Pleural Cavity, Neoadjuvant Therapy, Overall Survival, Histology, Dyspnea.

Related studies

• Helical tomotherapy for resected malignant pleural mesothelioma: dosimetric evaluation and toxicity — P. Giraud, A. Sylvestre, 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)
• Single-institution experience of intensity-modulated radiotherapy for malignant pleural mesothelioma at University of Catania — C. Spatola, C. Militello, et al. (2018)
• Improved Outcomes with Modern Lung-Sparing Trimodality Therapy in Patients with Malignant Pleural Mesothelioma — F. Shaikh, M.G. Zauderer, et al. (2017)
• 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)
• Dosimetric Comparison Between Helical Tomotherapy and Volumetric Modulated Arc Therapy in Patients With Malignant Pleural Mesothelioma — T. Müdder, G.R. Sarria, et al. (2022)

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