Single-institution experience of intensity-modulated radiotherapy for malignant pleural mesothelioma at University of Catania

Our plain-English summary of Single-institution experience of intensity-modulated radiotherapy for malignant pleural mesothelioma at University of Catania, by C. Spatola, C. Militello, A. Tocco, et al (Future Oncology, 2018).

The study

• Authors: C. Spatola, C. Militello, A. Tocco, V. Salamone, R. Luigi, M. Migliore, D. Marletta, A. Cannizzaro, R. Bevilacqua, P. Milone, S. Pergolizzi, G. Privitera
• Journal: Future Oncology
• Published: 2018;14(6s):17-21
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The multimodal approach to malignant pleural mesothelioma is gradually becoming the standard of care for this disease in patients with good performance status. Materials & methods: We report our experience concerning eight cases treated with the use of static step-and-shoot intensity-modulated radiotherapy to the whole pleural cavity, in patients already undergoing surgical and/or antiblastic therapy. Results & conclusion: Results at a median follow-up of 16 months showed a median survival from the initial treatment of 29 months, with lung toxicity of grade II reported only in two patients.

In plain English

This article reports one hospital's experience at the University of Catania, Italy, treating eight patients with malignant pleural mesothelioma between September 2015 and February 2017. All received a targeted radiotherapy technique (static step-and-shoot intensity-modulated radiotherapy, IMRT) aimed at the whole pleural cavity. The patients were aged 56 to 78 and had already had surgery and/or chemotherapy. The article does not describe asbestos exposure. Seven patients completed radiotherapy. One stopped early when their general condition worsened and died two months later from local spread of the disease. At a median follow-up of 16 months (range 6 to 23 months), seven patients were alive without signs of local relapse, though one had developed bone metastases. Median overall survival from initial treatment was 29 months. Grade II esophagitis occurred in 37% of patients and grade III in one. Grade II lung toxicity occurred in two patients, without symptoms and with full recovery. All four patients with chronic pain reported relief. The authors concluded that careful patient selection and correct timing of radiotherapy are essential. They noted that radiotherapy often started late.

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: Single-institution case series describing the authors' own experience with eight treated patients
• Who was studied: Eight patients with malignant pleural mesothelioma treated September 2015 to February 2017 at the University of Catania, Italy. They were aged 56 to 78 (median 69); six were male and two female. Five had epithelioid and three had mixed epithelioid/sarcomatoid tumors. Two were stage II and six stage III. Patients with stage IV disease or poor performance status were excluded.
• Exposure: The exposure studied was treatment, not asbestos: static step-and-shoot IMRT to the whole pleural cavity, given after surgery (pleurectomy/decortication in five patients, partial resection or biopsy in three) and/or chemotherapy. The prescribed dose was 50.4 Gy in 28 daily fractions of 1.8 Gy (printed as "504 Gy" and "18 Gy"; the discussion confirms about 50 Gy). Three patients received an extra boost to residual lesions. The article gives no information on asbestos exposure.
• Main results:
  • Seven of eight patients completed radiotherapy. One stopped at 42 Gy because their general condition worsened.
  • At a follow-up time of 16 months (range 6 to 23 months; called the median follow-up in the article's abstract), seven patients were alive without clinical or radiological signs of local relapse.
  • Median overall survival since the initial treatment was 29 months (range 18 to 43 months).
  • Restaging PET-CT scans showed a partial response of more than 50% in the three patients who had partial surgery or biopsy.
  • Pain relief was obtained in all four patients who had chronic moderate-to-severe pain before radiotherapy.
  • One patient developed distant bone metastases 8 months after radiotherapy ended.
  • One patient died from local progression of the disease 2 months after stopping radiotherapy.
  • Grade II esophagitis was reported in 37% of patients and grade III in one patient, with a recovery time of 30 days.
  • Grade II lung toxicity was reported in two patients 6 months after treatment. It caused no symptoms and fully resolved after 3 months.
  • Grade II anemia occurred in two patients, both of whom also received weekly cisplatin. No skin toxicity was reported.
• The authors' conclusion: The authors concluded that patients must be carefully selected by performance status and that radiotherapy must be timed correctly, so that it is not started late when patients' condition is already compromised. They also stated that multidisciplinary management of mesothelioma is mandatory.
• Limitations the authors state:
  • Radiotherapy was often given late (median 14 months after diagnosis) because patients had been followed at another center.
  • Late treatment can mean starting radiotherapy in patients with poor performance status. This happened to one patient, who had to stop treatment.

Topics

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

Medical terms in this study, explained in our Lexicon: Intensity-Modulated Radiation Therapy (IMRT), Pleural Mesothelioma, Performance Status, Pleural Cavity, Median Survival.

Related studies

• Intensity-modulated radiotherapy for relapsed malignant pleural mesothelioma — C. Spatola, C. Militello, et al. (2016)
• 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)
• Clinical experience of volumetric modulated arc therapy for malignant pleural mesothelioma after extrapleural pneumonectomy — T. Kimura, Y. Doi, et al. (2015)
• Extra-pleural pneumonectomy in the era of image-guided intensity-modulated radiotherapy — M. Trovo, D. Franceschini, 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)
• Intensity-modulated radiotherapy after extrapleural pneumonectomy in the combined-modality treatment of malignant pleural mesothelioma — A. Chi, Z. Liao, et al. (2011)

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