胸膜调强放疗治疗恶性胸膜间皮瘤。
Pleural intensity-modulated radiotherapy for malignant pleural mesothelioma.
机构信息
Department of Radiation Oncology, Mount Sinai Medical Center, New York, NY 10029, USA.
出版信息
Int J Radiat Oncol Biol Phys. 2012 Jul 15;83(4):1278-83. doi: 10.1016/j.ijrobp.2011.09.027. Epub 2012 May 18.
PURPOSE
In patients with malignant pleural mesothelioma who are unable to undergo pneumonectomy, it is difficult to deliver tumoricidal radiation doses to the pleura without significant toxicity. We have implemented a technique of using intensity-modulated radiotherapy (IMRT) to treat these patients, and we report the feasibility and toxicity of this approach.
METHODS AND MATERIALS
Between 2005 and 2010, 36 patients with malignant pleural mesothelioma and two intact lungs (i.e., no previous pneumonectomy) were treated with pleural IMRT to the hemithorax (median dose, 46.8 Gy; range, 41.4-50.4) at Memorial Sloan-Kettering Cancer Center.
RESULTS
Of the 36 patients, 56% had right-sided tumors. The histologic type was epithelial in 78%, sarcomatoid in 6%, and mixed in 17%, and 6% had Stage I, 28% had Stage II, 33% had Stage III, and 33% had Stage IV. Thirty-two patients (89%) received induction chemotherapy (mostly cisplatin and pemetrexed); 56% underwent pleurectomy/decortication before IMRT and 44% did not undergo resection. Of the 36 patients evaluable for acute toxicity, 7 (20%) had Grade 3 or worse pneumonitis (including 1 death) and 2 had Grade 3 fatigue. In 30 patients assessable for late toxicity, 5 had continuing Grade 3 pneumonitis. For patients treated with surgery, the 1- and 2-year survival rate was 75% and 53%, and the median survival was 26 months. For patients who did not undergo surgical resection, the 1- and 2-year survival rate was 69% and 28%, and the median survival was 17 months.
CONCLUSIONS
Treating the intact lung with pleural IMRT in patients with malignant pleural mesothelioma is a safe and feasible treatment option with an acceptable rate of pneumonitis. Additionally, the survival rates were encouraging in our retrospective series, particularly for the patients who underwent pleurectomy/decortication. We have initiated a Phase II trial of induction chemotherapy with pemetrexed and cisplatin with or without pleurectomy/decortication, followed by pleural IMRT to prospectively evaluate the toxicity and survival.
目的
对于不能进行肺切除术的恶性胸膜间皮瘤患者，要想在不引起严重毒性的情况下给予胸膜致死剂量的放射治疗是很困难的。我们采用了调强放疗（IMRT）技术来治疗这些患者，并报告了这种方法的可行性和毒性。
方法和材料
在 2005 年至 2010 年期间，在纪念斯隆-凯特琳癌症中心，36 例患有恶性胸膜间皮瘤且有两个完整肺（即无先前肺切除术）的患者接受了胸腔 IMRT 治疗（中位剂量为 46.8Gy；范围为 41.4-50.4）。
结果
36 例患者中，56%的肿瘤位于右侧。组织学类型为上皮型 78%，肉瘤样型 6%，混合型 17%，Ⅰ期 6%，Ⅱ期 28%，Ⅲ期 33%，Ⅳ期 33%。32 例（89%）患者接受了诱导化疗（主要为顺铂和培美曲塞）；56%的患者在 IMRT 前接受了胸膜切除术/剥脱术，而 44%的患者未行切除术。在 36 例可评估急性毒性的患者中，有 7 例（20%）发生 3 级或更严重的放射性肺炎（包括 1 例死亡），2 例发生 3 级乏力。在 30 例可评估晚期毒性的患者中，有 5 例持续存在 3 级放射性肺炎。对于接受手术治疗的患者，1 年和 2 年生存率分别为 75%和 53%，中位生存期为 26 个月。对于未行手术切除的患者，1 年和 2 年生存率分别为 69%和 28%，中位生存期为 17 个月。
结论
在恶性胸膜间皮瘤患者中采用胸膜 IMRT 治疗完整肺是一种安全可行的治疗选择，放射性肺炎发生率可接受。此外，在我们的回顾性研究中，生存率令人鼓舞，尤其是对于接受胸膜切除术/剥脱术的患者。我们已经启动了一项 II 期临床试验，采用顺铂和培美曲塞联合或不联合胸膜切除术/剥脱术进行诱导化疗，随后进行胸膜 IMRT，以前瞻性评估毒性和生存率。
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