Department of Radiation Oncology, Azienda Sanitaria Universitaria Integrata Udine, P.le Santa Maria della Misericordia 15, 33100, Udine, Italy.
Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Via Manzoni 56, Rozzano, Milan, Italy.
Radiol Med. 2019 Sep;124(9):854-859. doi: 10.1007/s11547-019-01030-y. Epub 2019 Apr 8.
To assess the outcome of malignant pleural mesothelioma patients treated with extra-pleural pneumonectomy (EPP) and adjuvant radiotherapy (RT), using the most advanced radiotherapeutic techniques, namely image-guided intensity-modulated RT (IG-IMRT).
Fifty-four patients were analyzed. Minimum radiation dose was 50 Gy (2 Gy/fr). Planning target volume encompassed the entire hemithorax, including the ipsilateral mediastinum if interested by disease, the pericardium and diaphragm, and any drain sites. The study endpoints included loco-regional control (LRC), distant metastases free survival (DMFS), and overall survival (OS), as well as radiation-related toxicity.
Major patients and treatment characteristics were the following: median age 62 years, epithelioid histology in 51 (94%) cases, locally advanced disease in 41 (90%) cases, and metastatic mediastinal lymph nodes in 27 patients (50%). Only 7 patients (13%) had gross residual disease after surgery. Chemotherapy was administered in 38 patients (70%). Median follow-up was 16 months (range 0-73 months). Median and 2-year OS were 21 months and was 43.8%, respectively. The predominant pattern of failure was distant: 34 patients (62.9%) developed some component of distant failure, and only 5 patients (9.2%) developed an isolated loco-regional recurrence. The estimates of LRC and DMFS at 2 years were 63.4% and 43.4%, respectively. Three fatal pneumonitis were documented. Other major toxicities included: Grade 2 and 3 pneumonitis in 1 and 2 cases, respectively, 1 case of bronchial fistula, pleural empyema, and Grade 3 esophagitis, respectively.
Although executed in the era of high-technology radiotherapy (IG-IMRT), EPP should not be routinely performed.
评估采用最先进的放射治疗技术（即图像引导强度调制放射治疗（IG-IMRT））进行胸膜外全肺切除术（EPP）和辅助放疗（RT）治疗的恶性胸膜间皮瘤患者的治疗结果。
分析了 54 例患者。最小放射剂量为 50Gy（2Gy/fr）。计划靶区包括整个半胸部，包括受累的同侧纵隔、心包和膈肌，以及任何引流部位。研究终点包括局部区域控制（LRC）、无远处转移生存（DMFS）和总生存（OS）以及放射相关毒性。
主要患者和治疗特征如下：中位年龄 62 岁，51 例（94%）为上皮样组织学，41 例（90%）为局部晚期疾病，27 例（50%）有转移性纵隔淋巴结。仅 7 例（13%）术后有明显残留病灶。38 例（70%）患者接受了化疗。中位随访时间为 16 个月（0-73 个月）。中位和 2 年 OS 分别为 21 个月和 43.8%。失败的主要模式是远处：34 例（62.9%）出现了远处失败的某些部分，仅有 5 例（9.2%）出现孤立的局部区域复发。2 年 LRC 和 DMFS 的估计值分别为 63.4%和 43.4%。记录了 3 例致命性放射性肺炎。其他主要毒性包括：1 例和 2 例分别为 2 级和 3 级放射性肺炎，1 例支气管瘘，脓胸和 3 级食管炎。
尽管在高技能放射治疗（IG-IMRT）时代实施，但不应常规进行 EPP。
