Related Experiment Video
Updated: Jun 24, 2026
Endobronchial Ultrasound-guided Intratumoral Injection of Cisplatin for the Treatment of Isolated Mediastinal Recurrence of Lung Cancer
Published on: February 12, 2017
Pulmonary toxicity following IMRT after extrapleural pneumonectomy for malignant pleural mesothelioma
Claus Andrup Kristensen1, Trine Juhler Nøttrup, Anne Kiil Berthelsen
1Department of Oncology, Copenhagen University Hospital/Rigshospitalet, Denmark. claus.andrup.kristensen@rh.regionh.dk
Background And Purpose:
The combination of chemotherapy, surgery, and radiotherapy has improved the prognosis for patients with malignant pleural mesothelioma (MPM). Intensity-modulated radiotherapy (IMRT) has allowed for an increase in dose to the pleural cavity and a reduction in radiation doses to organs at risk. The present study reports and analyses the incidence of fatal pulmonary toxicity in patients treated at Rigshospitalet, Copenhagen.
Materials And Methods:
Twenty-six patients were treated with induction chemotherapy followed by extrapleural pneumonectomy and IMRT between April 2003 and April 2006. The entire preoperative pleural surface area was treated to 50 Gy and areas with residual disease or close surgical margins were treated to 60 Gy in 30 fractions.
Results:
The main toxicities were nausea, vomiting, esophagitis, dyspnea, and thrombocytopenia. One patient died from an intracranial hemorrhage during severe thrombocytopenia. Four patients (15%) experienced grade 5 lung toxicity, i.e. pneumonitis 19-40 days after the completion of radiotherapy. Patients with pneumonitis had a significantly larger lung volume fraction receiving 10 Gy or more (V10) (median: 60.3%, range 56.4-83.2%) compared to patients without pneumonitis (median: 52.6%, range: 25.6-80.3%) (p=0.02). Mean lung dose (MLD) was also significantly higher in patients who developed pneumonitis (median 13.9 Gy, range: 13.6-14.2 Gy) than in patients who did not (median=12.4 Gy, range: 8.4-15.4 Gy) (p=0.04).
Conclusions:
Significant differences in MLD and V10 for patients with fatal pulmonary toxicity compared to patients without fatal lung toxicity have been demonstrated. Based on the presented data local lung dose constraints have been modified in order to avoid unacceptable toxicity.
Insights
High mean lung dose (MLD) and lung volume receiving 10 Gy or more (V10) correlate with fatal lung toxicity in malignant pleural mesothelioma (MPM) patients treated with intensity-modulated radiotherapy (IMRT). These findings led to modified lung dose constraints to minimize toxicity.
Area of Science:
- Oncology
- Radiation Oncology
- Thoracic Surgery
Background:
- Malignant pleural mesothelioma (MPM) treatment combines chemotherapy, surgery, and radiotherapy.
- Intensity-modulated radiotherapy (IMRT) enhances dose delivery to the pleural cavity while sparing organs at risk.
- This study analyzes fatal pulmonary toxicity in MPM patients treated at Rigshospitalet, Copenhagen.
Purpose of the Study:
- To report and analyze the incidence of fatal pulmonary toxicity in patients with malignant pleural mesothelioma (MPM).
- To evaluate the relationship between radiation dose parameters and the occurrence of severe lung toxicity.
- To inform modifications of radiotherapy dose constraints for improved patient safety.
Main Methods:
- Retrospective analysis of 26 MPM patients treated with induction chemotherapy, extrapleural pneumonectomy, and IMRT (2003-2006).
- Radiotherapy delivered 50 Gy to the entire pleural surface and 60 Gy to areas with residual disease or close margins.
- Pulmonary toxicity, specifically pneumonitis, was assessed, and dose-volume parameters (MLD, V10) were correlated with outcomes.
Main Results:
- Four patients (15%) experienced fatal (Grade 5) pneumonitis post-radiotherapy.
- Patients with pneumonitis showed significantly higher V10 (median 60.3% vs. 52.6%, p=0.02) and MLD (median 13.9 Gy vs. 12.4 Gy, p=0.04).
- Other toxicities included nausea, vomiting, esophagitis, dyspnea, and thrombocytopenia, with one death from intracranial hemorrhage.
Conclusions:
- Elevated Mean Lung Dose (MLD) and high lung volume receiving 10 Gy or more (V10) are significant risk factors for fatal pulmonary toxicity in MPM patients.
- The study identified critical dose thresholds associated with severe lung toxicity.
- Modified local lung dose constraints were implemented based on these findings to reduce unacceptable toxicity in future treatments.
More Related Videos
Related Concept Videos
01:27Pneumothorax-II
Clinical Manifestations:
01:28Pleural Effusion II: Symptoms and Management
A pleural effusion is the abnormal collection of fluid between the parietal and visceral pleura layers of tissue that form the lining of the lungs and chest cavity. It can occur independently or due to surrounding parenchymal diseases, such as infection, malignancy, or inflammatory conditions.
Clinical Manifestations:
01:13Radiological Investigation III: Pulmonary Angiogram and PET Scan
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...
01:30Pleural Disorders: Types and Brief Description