Skip to main content

Advertisement

SpringerLink
Log in

Extra-pleural pneumonectomy in the era of image-guided intensity-modulated radiotherapy

  • RADIOTHERAPY
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

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).

Methods and materials

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.

Results

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.

Conclusions

Although executed in the era of high-technology radiotherapy (IG-IMRT), EPP should not be routinely performed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Zellos L, Christiani DC (2004) Epidemiology, biologic behavior, and natural history of mesothelioma. Thorac Surg Clin 14:469–477

    Article  Google Scholar 

  2. Sugarbaker DJ, Flores RM, Jaklitsch MT et al (1999) Resection margins, extrapleural nodal status, and cell type determine postoperative ling-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients. J Thorac Cardiovasc Surg 117:54–65

    Article  CAS  Google Scholar 

  3. Flores MR, Pass IH, Seshan EV et al (2008) Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: results in 663 patients. J Thorac Cardiovasc Surg 135:620–626

    Article  Google Scholar 

  4. Treasure T, Lang-Lazdunski L, Waller D et al (2011) Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma: clinical outcomes of the mesothelioma and radical surgery (MARS) randomized feasibility study. Lancet Oncol 12:763–772

    Article  Google Scholar 

  5. Cao C, Tian DH, Wolfenden H et al (2014) Meta-analysis of different procedures: the importance of recognizing the spectrum of pleurectomy/decortication techniques. Lung Cancer 83:240–245

    Article  Google Scholar 

  6. Stahel RA, Riesterer O, Xyrafas A et al (2015) Neoadjuvant chemotherapy and extrapleural pneumonectomy of malignant pleural mesothelioma with or without hemithoracic radiotherapy (SAKK 17/04): a randomised, international, multicentre phase 2 trial. Lancet Oncol 16:1651–1658

    Article  Google Scholar 

  7. Forster KM, Smythe WR, Starkshall G et al (2002) Intensity-modulated radiotherapy following extra-pleural pneumonectomy fro the treatment of malignant mesothelioma: clinical implementation. Int J Radiat Oncol Biol Phys 55:606–616

    Article  Google Scholar 

  8. Giraud P, Sylvestre A, Zefkili S et al (2011) Helical tomotherapy for resected malignant pleural mesothelioma: dosimetric evaluation and toxicity. Radiother Oncol 101:303–306

    Article  Google Scholar 

  9. Scorsetti M, Bignardi M, Clivio A et al (2010) Volumetric modulation arc radiotherapy compared with static gantry intensity-modulated radiotherapy for malignant pleural mesothelioma tumor: a feasibility study. Int J Radiat Oncol Biol Phys 77:942–949

    Article  Google Scholar 

  10. Ahamad A, Stevens CG, Smythe WR et al (2003) Intensity-modulated radiation therapy: a novel approach to the management of malignant pleural mesothelioma. Int J Radiat Oncol Biol Phys 55:768–775

    Article  Google Scholar 

  11. Casiraghi M, Maisonneuve P, Brambilla D et al (2017) Induction chemotherapy, extrapleural pneumonectomy and adjuvant radiotherapy for malignant pleural mesothelioma. Eur J Cardiothorac Surg 52:975–981

    Article  Google Scholar 

  12. De Perrot M, Field B, Cho BC et al (2009) Trimodality therapy with induction chemotherapy followed by extrapleural pneumonectomy and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma. J Clin Oncol 27:1413–1418

    Article  Google Scholar 

  13. Krug LM, Pass HI, Rusch VW et al (2009) Multicenter phase II trial of neoadjuvant pemetrexed plus cisplatin followed by extrapleural pneumonectomy and radiation for malignant pleural mesothelioma. J Clin Oncol 20:3007–3013

    Article  Google Scholar 

  14. Patel RP, Yoo S, Broadwater G et al (2011) Effect of increasing experience on dosimetric and clinical outcomes in the management of malignant pleural mesothelioma with intensity-modulated radiation therapy. Int J Radiat Oncol Biol Phys 83:362–368

    Article  Google Scholar 

  15. Gomez RD, Hong SA, Allen KP et al (2013) Patterns of failure, toxicity, and survival after extrapleural pneumonectomy and hemithoracic intensity-modulated radiation therapy for malignant pleural mesotelioma. J Thorac Oncol 8:238–245

    Article  Google Scholar 

  16. Thieke C, Nicolay HN, Sterzing F et al (2015) Long-term results in malignant pleural mesothelioma treated with neoadjuvant chemotherapy, extrapleural pneumonectomy and intensity-modulated radiotherapy. Radiat Oncol 10:267–277

    Article  Google Scholar 

  17. Minatel E, Trovo M, Bearz A et al (2015) Radical radiation therapy after lung-sparing surgery for malignant pleural mesothelioma: survival, pattern of failure, and prognostic factors. Int J Radiat Oncol Biol Phys 93:606–613

    Article  Google Scholar 

  18. Rosenzweig KE, Zauderer MG, Laser B et al (2012) Pleural intensity-modulated radiotherapy for malignant pleural mesothelioma. Int J Radiat Oncol Biol Phys 83:1278–1283

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Azienda Sanitaria Universitaria Integrata Udine, P.le Santa Maria della Misericordia 15, 33100, Udine, Italy

    Marco Trovo & Giuseppe Parisi

  2. Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Via Manzoni 56, Rozzano, Milan, Italy

    Davide Franceschini

  3. Department of Radiation Oncology, Ospedale San Martino di Belluno, Viale Europa 22, 32100, Belluno, Italy

    Carlo Furlan & Francesca Pietrobon

  4. Department of Radiation Oncology, Azienda Ospedaliera Universitaria San Martino di Genova - IST, Istituto Nazionale Ricerca sul Cancro, Largo Rosanna Benzi, 10, 16132, Genoa, Italy

    Stefano Vagge

  5. Radiation Oncology Department, National Cancer Institute, CRO IRCCS, Via Franco Gallini, 2, 33081, Aviano, PN, Italy

    Eleonora Farina & Alberto Revelant

  6. Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy

    Luca Visani, Virginia Maragna & Vieri Scotti

Authors
  1. Marco Trovo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Davide Franceschini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carlo Furlan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesca Pietrobon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stefano Vagge
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eleonora Farina
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alberto Revelant
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Luca Visani
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Virginia Maragna
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Giuseppe Parisi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Vieri Scotti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giuseppe Parisi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Trovo, M., Franceschini, D., Furlan, C. et al. Extra-pleural pneumonectomy in the era of image-guided intensity-modulated radiotherapy. Radiol med 124, 854–859 (2019). https://doi.org/10.1007/s11547-019-01030-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-019-01030-y

Keywords

Search

Navigation