Accelerated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma

作者：de Perrot Marc^*; Feld Ronald; Leighl Natasha B; Hope Andrew; Waddell Thomas K; Keshavjee Shaf; Cho B C John

来源：The Journal of Thoracic and Cardiovascular Surgery, 2016, 151(2): 468-475.

DOI：10.1016/j.jtcvs.2015.09.129

• mesothelioma
• MPM
• short course radiation
• surgery

Objective: To evaluate a new protocol of accelerated hemithoracic intensity-modulated radiation therapy (IMRT) followed by extrapleural pneumonectomy (EPP) for patients with resectable malignant pleural mesothelioma (MPM).
Methods: A total of 25 Gy of radiation was delivered in 5 daily fractions over 1 week to the entire ipsilateral hemithorax with concomitant boost of 5 Gy to volumes at high risk based on computed tomography and positron emission tomography scan findings. EPP was performed at 6 +/- 2 days after the end of radiation therapy. Adjuvant chemotherapy was offered to patients with ypN2 disease.
Results: A total of 62 patients were included between November 2008 and October 2014. One patient died in the hospital 2 months after EPP, for an operative mortality of 1.6%, and 2 died after discharged from the hospital for an overall treatment-related mortality (grade 5 toxicity) of 4.8%. Twenty-four patients (39%) developed grade 3 to 5 (grade 3+) complications. On final pathology, 94% of the patients were stage III or IV, and 52% had ypN2 disease. The median survival for all patients as an intention-to-treat analysis was 36 months. The median overall survival and disease-free survival was 51 and 47 months, respectively, in epithelial subtypes, compared with 10 and 8 months in biphasic subtypes (P=.001). Ipsilateral chest recurrence occurred in 8 patients.
Conclusions: Accelerated hemithoracic IMRT followed by EPP has become our preferred approach for resectable MPM. The results have been encouraging in patients with epithelial subtype.

• 出版日期2016-2