HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): David C. Rice Ara A. Vaporciyan Garrett L. Walsh Stephen G. Swisher Wayne L. Hofstetter Reza J. Mehran Jack A. Roth Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rice, D. C. Articles by Smythe, W. R. Search for Related Content PubMed PubMed Citation Articles by Rice, D. C. Articles by Smythe, W. R. Related Collections Pleura

---

Original Articles: General Thoracic

Outcomes After Extrapleural Pneumonectomy and Intensity-Modulated Radiation Therapy for Malignant Pleural Mesothelioma

^a Department of Thoracic and Cardiovascular Surgery, University of Texas, MD Anderson Cancer Center, Houston, Texas
^b Department of Thoracic Medical Oncology, University of Texas, MD Anderson Cancer Center, Houston, Texas
^c Department of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, Texas
^d Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
^e Department of Surgery, Scott and White Clinic, Temple, Texas

Accepted for publication April 23, 2007.

^_* Address correspondence to Dr Rice, Department of Thoracic and Cardiovascular Surgery, Box 445, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (Email: drice{at}mdanderson.org).

Presented at the Fifty-third Annual Meeting of the Southern Thoracic Surgical Association, Tucson, AZ, Nov 8–11, 2006.

Background: Malignant pleural mesothelioma is a locally aggressive tumor that is usually fatal. Extrapleural pneumonectomy (EPP) followed by hemithoracic irradiation has shown promise, but local failure remains a significant problem. To improve local control, we have used intensity-modulated radiation therapy (IMRT) as it allows better dose distribution to regions at risk of recurrence as well as reduced radiation to surrounding organs.

Methods: One hundred consecutive patients underwent EPP. At a median interval of 2.5 months from surgery, 63 patients received IMRT (median dose 45 Gy) with curative intent. Chemotherapy was not routinely administered.

Results: Tumors were right sided in 66 patients (66%) and nonepithelioid in 33 (33%). American Joint Committee on Cancer pathology stage was I in 6 patients (6%), II in 7 (7%), III in 72 (72%), and IV (T4) in 15 (15%). Fifty-four patients (54%) had ipsilateral nodal metastases. Perioperative mortality was 8%. Median overall survival (n = 100) was 10.2 months. For patients who received IMRT (n = 63), median overall and 3-year survival was 14.2 months and 20%. Of these, node-negative patients with epithelioid histology (n = 18) had median and 3-year survival of 28 months and 41%. Distant recurrences occurred in 33 of 61 evaluable patients (54%). Eight patients (13%) had local or regional recurrence, 5 of whom also recurred distally. Only 3 patients (5%) had recurrence within the irradiated field.

Conclusions: Intensity-modulated radiation therapy after EPP results in excellent local control for malignant pleural mesothelioma; however, distant metastases remain a significant problem and limit survival. This provides a strong rationale for combining aggressive local regimens with systemic therapy.

This article has been cited by other articles:

				R. A. Stahel, W. Weder, E. Felip, and On behalf of the ESMO Guidelines Working Group Malignant pleural mesothelioma: ESMO Clinical Recommendations for diagnosis, treatment and follow-up Ann. Onc., May 1, 2009; 20(suppl_4): iv73 - iv75. [Full Text] [PDF]

				A. S. Tsao, I. Wistuba, J. A. Roth, and H. L. Kindler Malignant Pleural Mesothelioma J. Clin. Oncol., April 20, 2009; 27(12): 2081 - 2090. [Abstract] [Full Text] [PDF]

				M. de Perrot, R. Feld, B.C. J. Cho, A. Bezjak, M. Anraku, R. Burkes, H. Roberts, M. S. Tsao, N. Leighl, S. Keshavjee, et al. Trimodality Therapy With Induction Chemotherapy Followed by Extrapleural Pneumonectomy and Adjuvant High-Dose Hemithoracic Radiation for Malignant Pleural Mesothelioma J. Clin. Oncol., March 20, 2009; 27(9): 1413 - 1418. [Abstract] [Full Text] [PDF]

				T. Treasure Are randomised trials needed in the era of rapidly evolving technologies? Eur. J. Cardiothorac. Surg., March 1, 2009; 35(3): 474 - 478. [Abstract] [Full Text] [PDF]

				H. I. Pass, G. J. Brewer, R. Dick, M. Carbone, and S. Merajver A Phase II Trial of Tetrathiomolybdate After Surgery for Malignant Mesothelioma: Final Results Ann. Thorac. Surg., August 1, 2008; 86(2): 383 - 390. [Abstract] [Full Text] [PDF]

				T. C. Mineo, V. Ambrogi, E. Pompeo, A. Baldi, F. Stella, P. Aurea, and M. Marino The Value of Occult Disease in Resection Margin and Lymph Node After Extrapleural Pneumonectomy for Malignant Mesothelioma Ann. Thorac. Surg., May 1, 2008; 85(5): 1740 - 1746. [Abstract] [Full Text] [PDF]