Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan.
Department of Radiology, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, 466-8650, Japan.
J Radiat Res. 2022 Mar 17;63(2):281-289. doi: 10.1093/jrr/rrab127.
We conducted a nationwide survey of tomotherapy for malignant pleural mesothelioma (MPM) in Japan. Fifty-six facilities were surveyed and data on 31 patients treated curatively between 2008 and 2017 were collected from 14 facilities. Twenty patients received hemithorax irradiation after extrapleural pneumonectomy (EPP) (first group). Five patients received irradiation without EPP (second group), while six received salvage radiotherapy for local recurrence (salvage group). Among the seven patients not undergoing EPP, five (four in the second group and one in the salvage group) were treated with lung sparing pleural irradiation (LSPI) and two with irradiation to visible tumors. Two-year overall survival (OS) rates in the first and second groups were 33% and 60%, respectively (median, 13 vs 30 months, P = 0.82). In the first and second groups, 2-year local control (LC) rates were 53 and 67%, respectively (P = 0.54) and 2-year progression-free survival (PFS) rates were 16% and 60%, respectively (P = 0.07). Distant metastases occurred in 15 patients in the first group and three in the second group. In the salvage group, the median OS was 18 months. Recurrence was observed in the irradiated volume in four patients. The contralateral lung dose was higher in LSPI than in hemithorax irradiation plans (mean, 11.0 ± 2.2 vs 6.1 ± 3.1 Gy, P = 0.002). Grade 3 or 5 lung toxicity was observed in two patients receiving EPP and hemithorax irradiation, but not in those undergoing LSPI. In conclusion, outcomes of EPP and hemithorax irradiation were not satisfactory, whereas LSPI appeared promising and encouraging.
我们对日本的恶性胸膜间皮瘤（MPM）的调强放疗进行了全国性调查。对 56 个机构进行了调查，并从 14 个机构收集了 2008 年至 2017 年期间接受根治性治疗的 31 名患者的数据。20 名患者在进行胸膜外肺切除术（EPP）后接受半胸照射（第一组）。5 名患者未行 EPP 而接受照射（第二组），6 名患者因局部复发而行挽救性放疗（挽救组）。在未行 EPP 的 7 名患者中，5 名（第二组 4 名，挽救组 1 名）行肺保护胸膜照射（LSPI），2 名行肉眼可见肿瘤照射。第一组和第二组的 2 年总生存率（OS）分别为 33%和 60%（中位数分别为 13 个月和 30 个月，P=0.82）。第一组和第二组的 2 年局部控制率（LC）分别为 53%和 67%（P=0.54），2 年无进展生存率（PFS）分别为 16%和 60%（P=0.07）。第一组中有 15 名患者发生远处转移，第二组中有 3 名患者发生远处转移。挽救组的中位 OS 为 18 个月。在照射体积中观察到 4 例复发。LSPI 组的对侧肺剂量高于半胸照射计划（均值，11.0±2.2 Gy 比 6.1±3.1 Gy，P=0.002）。接受 EPP 和半胸照射的 2 名患者发生 3 级或 5 级肺毒性，但接受 LSPI 的患者未发生。总之，EPP 和半胸照射的结果并不令人满意，而 LSPI 似乎有希望且令人鼓舞。
