High-dose palliative radiotherapy for malignant pleural mesothelioma

Area of Science:

• Oncology
• Radiation Oncology
• Thoracic Oncology

Background:

• High-dose hemithoracic radiotherapy for malignant pleural mesothelioma is a controversial treatment modality.
• This retrospective study examines outcomes from a policy of administering at least 45 Gy hemithoracic radiotherapy between 2003 and 2013.

Purpose of the Study:

• To report survival, disease progression, and toxicity associated with high-dose hemithoracic radiotherapy in malignant pleural mesothelioma.
• To evaluate the efficacy and safety of hemithoracic radiotherapy in a cohort of mesothelioma patients.

Main Methods:

• A retrospective analysis of 71 patients with pleural mesothelioma treated with 45-60 Gy radiotherapy.
• Utilized conformal radiotherapy (3D-CRT) for 17 patients and intensity-modulated radiotherapy (IMRT) for 54 patients.
• All patients were followed for at least 2 years post-radiotherapy initiation.

Main Results:

• Median overall survival was 9.5 months and median progression-free survival was 4.9 months.
• 87% of patients progressed or died within 2 years; severe toxicity (grade 3-5) occurred in 53% (3D-CRT) and 78% (IMRT) of patients.
• Common toxicities included pulmonary fibrosis (27%), radiation dermatitis (18%), and dyspnea (11%); 2-3 treatment-related deaths were reported.

Conclusions:

• High-dose hemithoracic radiotherapy in malignant pleural mesothelioma leads to substantial toxicity with no survival benefit.
• Lower doses of radiotherapy to limited volumes may offer palliative benefits for mesothelioma patients.
• The findings suggest a re-evaluation of high-dose hemithoracic radiotherapy strategies for malignant pleural mesothelioma is warranted.