Radiation May Prevent Metastases at Thoracoscopy Sites in Mesothelioma Patients

I enjoyed the review of malignant mesothelioma by Drs. Sean Grondin and David J. Sugarbaker that appeared in the July 1999 issue of oncology. On page 920, the authors mention that mesothelioma will recur locally at sites of pleuroscopy or thoracoscopy. From a radiation therapy standpoint, it is worth bringing to the readers’ attention that a small, prospective trial published by Boutin et al in Chest (108[3]:754-758, 1995) showed that radiotherapy to these sites prevents entry tract metastases. A radiation dose of 21 Gy in three fractions given 10 to 15 days after thoracoscopy decreased the incidence of entry tract metastases from 40% to 0%. This regimen should be considered for patients who will not receive a more definitive surgical procedure and adjuvant radiotherapy.

VOLKER W. STIEBER, MD
FellowAdvanced Radiation OncologyMayo ClinicJacksonville, Florida