(P100) Intensity-Modulated Radiation Therapy After Extrapleural Pneumonectomy With and Without Chemotherapy for Malignant Pleural Mesothelioma: No Fatal Pulmonary Toxicity and Long-Term Survival

OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

In our patient population, strict adherence to lung dose constraints during IMRT resulted in improved outcomes without fatal toxicity.

Sameer Jhavar, J. Pruszynski, Y. Liu, A. Gowan, P. Rascoe, N. Thawani, N. Deb, Mehul Patel; Baylor Scott and White Hospital, Texas A&M Medical Sciences Center

PURPOSE: Intensity-modulated radiation therapy (IMRT) after extrapleural pneumonectomy (EPP) for malignant pleural mesothelioma (MPM) has been associated with fatal pulmonary toxicity. A single-institution experience with IMRT following EPP for MPM is reported.

METHODS: Between 2005 and 2014, a total of 18 patients with MPM were treated with EPP followed by hemithoracic IMRT. IMRT target volume was the entire hemithorax and the thoracotomy and chest tube incision sites. Patients were treated with a median dose of 4,500 cGy in 25 fractions. Kaplan-Meier curves were used to graphically asses the overall survival (OS) and relapse-free survival (RFS). Median survival times are reported for both OS and RFS.

RESULTS: Of the 18 patients analyzed, 17 were males, and 11 had right-sided tumors. Median age was 54 years (range: 40–76 yr). The most common histology was epithelioid type. Chemotherapy was neoadjuvant in four and adjuvant in seven patients. A total of 3, 12, and 3 patients had pathological American Joint Committee on Cancer (AJCC) stages II, III, and IV, respectively. Involvement of surgical margin, lymphovascular space, pericardium, and chest wall was seen in 9, 7, 12, and 3 patients, respectively. The highest and lowest mean lung dose (MLD) was 9.3 Gy and 5 Gy, respectively, with a mean of 7.14 Gy. The highest V20 (normal lung volume receiving ≤20 Gy) was 7%, and the mean V20 was 2.23% (range: 0%–7%). At a median follow-up of 3 years, 8 patients were alive and 10 patients were dead. Ten (55%) patients experienced disease recurrence. The median RFS and OS were 29.67 months (95% confidence interval [CI], 11.79–78.1 mo) and 38.2 months (95% CI, 17.4–78.1 mo), respectively. No grade 3 acute toxicities were seen. No grade 3 or fatal pulmonary toxicities have been reported.

CONCLUSION: In our patient population, strict adherence to lung dose constraints during IMRT resulted in improved outcomes without fatal toxicity.

Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
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