Radiotherapy of the pleural cavity in patients with primary and secondary malignancies of the pleura.

BACKGROUND

Although there have been various attempts to find appropriate treatment from best conservative care to multimodal treatments, curative outcomes remain poor.

MATERIALS AND METHODS

30 patients with primary and secondary malignant tumors of the pleura were treated in the Radiotherapy Clinic of USHATO during the period from December 2016 to April 2023. Video-assisted thoracoscopic surgery (VATS) and talc pleurodesis was performed in 18 patients (60%). In all patients, radiotherapy for the pleura was performed on a helical tomotherapy machine. In 21 patients (70%), normal fractionated radiotherapy was performed at daily dose of 1.8-2 Gy to total dose of 40 Gy (5 times a week), and in 6 patients (20%), integrated surdosage to 50 Gy was also performed for visible lesions. Hypofractionated radiotherapy (10 fractions of 3 Gy and 4 fractions of 4 Gy) was performed in 3 (10%) patients.

RESULTS

Patients were followed up from 1 month to 57 months (median 14 months) or until death. The observed median survival for all patients was 19.2 months [95% confidence interval (CI): 11.5-26.9] (Fig. 3). The 1-, 2- and 3-year survival rates were 40%, 23% and 7% of patients, respectively. Malignant mesothelioma patients had 1-, 2- and 3-year survival rates of 31%, 10% and 0%, respectively. The 1-, 2-, and 3-year survival rates for patients with secondary malignancies were 54%, 45%, and 18%, respectively.

CONCLUSION

Our results suggest that helical tomotherapy is a feasible therapeutic option for patients with malignant mesothelioma or malignant secondary pleural involvement with a reasonable toxicity profile relative to other unaffected lung.