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Implantation and Monitoring by PET/CT of an Orthotopic Model of Human Pleural Mesothelioma in Athymic Mice
Published on: December 21, 2019
Radiation therapy options for malignant pleural mesothelioma
1Department of Radiation Oncology, Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts 02115, USA. ebaldini@lroc.harvard.edu
Seminars in Thoracic and Cardiovascular Surgery
|October 14, 2009
Summary
Radiation therapy (RT) for malignant pleural mesothelioma is not well-defined. While intensity-modulated radiation therapy (IMRT) shows promise, caution is advised due to potential severe toxicity, especially after surgery.
Area of Science:
- Oncology
- Radiation Oncology
- Thoracic Surgery
Background:
- The role of radiation therapy (RT) in the curative treatment of malignant pleural mesothelioma is not clearly established.
- Historically, RT has been associated with unacceptable toxicity, but recent advancements like intensity-modulated radiation therapy (IMRT) suggest potential tolerability.
- Adjuvant RT after pleurectomy presents challenges with unclear efficacy, and IMRT to the pleural envelope may not cover disease in fissures.
Purpose of the Study:
- To evaluate the current role and challenges of radiation therapy (RT) in the management of malignant pleural mesothelioma.
- To assess the feasibility, efficacy, and toxicity of different RT techniques, including IMRT, in the context of mesothelioma treatment.
- To provide guidance on the appropriate use of RT, particularly after extrapleural pneumonectomy, and highlight areas for future research.
Main Methods:
- Review of existing literature on radiation therapy techniques for malignant pleural mesothelioma.
- Analysis of data regarding the efficacy and toxicity of conventional RT, IMRT, and other advanced techniques.
- Evaluation of RT delivery challenges, including target volume definition and dose constraints for organs at risk, especially post-extrapleural pneumonectomy.
Main Results:
- Definitive RT for unresected mesothelioma lacks supporting data and may carry unacceptable toxicity.
- IMRT shows potential feasibility and tolerability for mesothelioma, but coverage of disease in fissures remains a concern.
- Post-extrapleural pneumonectomy RT is complex due to large target volumes and sensitive adjacent structures; IMRT offers the best dosimetry but carries risks of severe toxicity.
Conclusions:
- Current evidence does not support definitive RT for unresected malignant pleural mesothelioma.
- IMRT is the most promising RT technique for mesothelioma, particularly after extrapleural pneumonectomy, but requires experienced teams due to potential severe toxicity.
- Further research into predictive factors for complications and novel techniques like helical tomotherapy is needed to optimize RT for mesothelioma.
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