Hemithoracic Intensity Modulated Radiation Therapy After Pleurectomy/Decortication for Malignant Pleural Mesothelioma: Toxicity, Patterns of Failure, and a Matched Survival Analysis
| Autor: | Hubert Y. Pan, Joe Y. Chang, Reza J. Mehran, David C. Rice, William W. Chance, Anne S. Tsao, Chad Tang, Daniel R. Gomez, James W. Welsh, Pamela K. Allen, Zhongxing Liao, Hiral P. Fontanilla |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male Mesothelioma Cancer Research medicine.medical_specialty Vital capacity Lung Neoplasms Pleural Neoplasms medicine.medical_treatment Urology Disease-Free Survival Pulmonary function testing Humans Medicine Radiology Nuclear Medicine and imaging Treatment Failure Four-Dimensional Computed Tomography Pneumonectomy Radiation Injuries Lung Survival analysis Aged Skin Postoperative Care Radiation Performance status business.industry Mesothelioma Malignant Common Terminology Criteria for Adverse Events Middle Aged Decortication medicine.disease Combined Modality Therapy Survival Analysis Surgery Gastrointestinal Tract Radiation therapy Oncology Case-Control Studies Pleura Female Radiotherapy Intensity-Modulated Neoplasm Recurrence Local business |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 91:149-156 |
| ISSN: | 0360-3016 |
| Popis: | Purpose To investigate safety, efficacy, and recurrence after hemithoracic intensity modulated radiation therapy after pleurectomy/decortication (PD-IMRT) and after extrapleural pneumonectomy (EPP-IMRT). Methods and Materials In 2009-2013, 24 patients with mesothelioma underwent PD-IMRT to the involved hemithorax to a dose of 45 Gy, with an optional integrated boost; 22 also received chemotherapy. Toxicity was scored with the Common Terminology Criteria for Adverse Events v4.0. Pulmonary function was compared at baseline, after surgery, and after IMRT. Kaplan-Meier analysis was used to calculate overall survival (OS), progression-free survival (PFS), time to locoregional failure, and time to distant metastasis. Failures were in-field, marginal, or out of field. Outcomes were compared with those of 24 patients, matched for age, nodal status, performance status, and chemotherapy, who had received EPP-IMRT. Results Median follow-up time was 12.2 months. Grade 3 toxicity rates were 8% skin and 8% pulmonary. Pulmonary function declined from baseline to after surgery (by 21% for forced vital capacity, 16% for forced expiratory volume in 1 second, and 19% for lung diffusion of carbon monoxide [ P for all = .01]) and declined still further after IMRT (by 31% for forced vital capacity [ P =.02], 25% for forced expiratory volume in 1 second [ P =.01], and 30% for lung diffusion of carbon monoxide [ P =.01]). The OS and PFS rates were 76% and 67%, respectively, at 1 year and 56% and 34% at 2 years. Median OS (28.4 vs 14.2 months, P =.04) and median PFS (16.4 vs 8.2 months, P =.01) favored PD-IMRT versus EPP-IMRT. No differences were found in grade 4-5 toxicity (0 of 24 vs 3 of 24, P =.23), median time to locoregional failure (18.7 months vs not reached, P not calculable), or median time to distant metastasis (18.8 vs 11.8 months, P =.12). Conclusions Hemithoracic intensity modulated radiation therapy after pleurectomy/decortication produced little high-grade toxicity but led to progressive declines in pulmonary function; OS and PFS were better in PD-IMRT compared with EPP-IMRT. |
| Databáze: | OpenAIRE |
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