Franceschini Davide, Ghirardelli Paolo, Frrokaj Patricia, Andratschke Nicolaus H, Nicosia Luca, Parisi Elisabetta, Piperno Gaia, Sepulcri Matteo, Alì Emanuele, Marzo Antonio Marco, Bendoni Stefano, Spoto Ruggero, Krengli Marco, Ciammella Patrizia, Jereczek-Fossa Barbara A, Romeo Antonino, Mazzola Rosario, Alongi Filippo, Guckenberger Matthias, Ceresoli Giovanni Luca, Loi Mauro, Borghetti Paolo, Scorsetti Marta
Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy.
Department of Radiotherapy, Cliniche Humanitas Gavazzeni, via Gavazzeni 21, 24125 Bergamo, Italy.
Cancers (Basel). 2025 Aug 27;17(17):2797. doi: 10.3390/cancers17172797.
BACKGROUND/OBJECTIVES: This multicenter retrospective study aims to evaluate the role of Ablative Radiotherapy (RT) in patients with unresectable pleural mesothelioma (PM) who experienced radiological progression after at least one line of chemotherapy, with a maximum involvement of three pleural or extrapleural sites.
Adult patients (≥18 years) with PM treated with stereotactic radiotherapy between 2011 and 2022, limited to a maximum of three pleural or extrapleural sites, were included in the analysis. Ablative RT was required to be administered with radical intent. Endpoints were time to further systemic therapy (TFST), local control (LC), progression-free survival (PFS), overall survival (OS), and acute and late radiotherapy-related toxicity.
A total of 56 patients were identified from six Italian and one Swiss radiotherapy center. Treatment was generally well tolerated. Ten patients experienced grade 1 or 2 acute toxicity, while four patients reported persistent chest pain, with one case reaching grade 3 as late toxicity. The median TFST was 18.6 months, with TFST rates of 61.7% and 46.4% at 12 and 24 months, respectively. The median OS was 37.63 months, with 1- and 2-year OS rates of 85.2% and 65.6%. Local control was favorable (79% at 1 year), but most patients experienced disease recurrence outside the SABR treatment volume. The median disease progression-free survival (DPFS) was 8.17 months, with 1- and 2-year DPFS rates of 36% and 19%, respectively. Smoking history correlated with OS and DPFS in univariate analysis, while statistical significance for OS was maintained in multivariate analysis. Additionally, nodal status and PTV volume were associated with OS.
SABR is a safe and effective approach for the treatment of oligorecurrent/oligoprogressive PM. The time to further systemic therapy was extended up to 18 months. At two years, 10% of patients remained disease-free, and more than half were alive at three years, suggesting a potentially indolent biological behavior in oligometastatic PM.
背景/目的：本多中心回顾性研究旨在评估立体定向放射治疗（RT）在至少接受过一线化疗后出现影像学进展、胸膜或胸外部位最大累及三个的不可切除胸膜间皮瘤（PM）患者中的作用。
纳入2011年至2022年间接受立体定向放射治疗的成年（≥18岁）PM患者，分析限于最多三个胸膜或胸外部位。立体定向放射治疗需以根治为目的进行。观察终点为至进一步全身治疗时间（TFST）、局部控制（LC）、无进展生存期（PFS）、总生存期（OS）以及放疗相关的急性和晚期毒性。
从六个意大利和一个瑞士放疗中心共识别出56例患者。治疗总体耐受性良好。10例患者出现1级或2级急性毒性，4例患者报告持续胸痛，其中1例达到3级晚期毒性。中位TFST为18.6个月，12个月和24个月时的TFST率分别为61.7%和46.4%。中位OS为37.63个月，1年和2年OS率分别为85.2%和65.6%。局部控制良好（1年时为79%），但大多数患者在立体定向体部放射治疗（SABR）靶区外出现疾病复发。中位疾病无进展生存期（DPFS）为8.17个月，1年和2年DPFS率分别为36%和19%。单因素分析中吸烟史与OS和DPFS相关，多因素分析中OS仍具有统计学意义。此外，淋巴结状态和计划靶体积（PTV）与OS相关。
SABR是治疗寡复发/寡进展性PM的一种安全有效的方法。至进一步全身治疗的时间延长至18个月。两年时，10%的患者无疾病，三年时超过一半的患者存活，提示寡转移PM可能具有惰性生物学行为。
