Radical Pleurectomy/Decortication Followed by High Dose of Radiation Therapy for Malignant Pleural Mesothelioma. Final Results with Long-term Follow-up
Menée sur 20 patients atteints d'un mésothéliome pleural malin (durée médiane de suivi : 27 mois), cette étude prospective évalue l'efficacité, du point de vue du contrôle loco-régional, de la survie sans progression et de la survie globale à 2 et 3 ans, ainsi que la toxicité d'un traitement comprenant une pleurectomie radicale avec décortication puis une radiothérapie à dose élevée de rayonnements
Purpose : We have previously shown the feasibility of delivering high doses of radiotherapy in Malignant Pleural Mesothelioma (MPM) patients who underwent radical pleurectomy/decortication (P/D) or surgical biopsy. In this report we present the long-term results of MPM patients treated with radical P/D followed by high doses of radiotherapy. Methods and Materials : Twenty consecutive MPM patients were enrolled in this prospective study and underwent radical P/D followed by high dose radiotherapy. The clinical target volume was defined as the entire hemithorax excluding the intact lung. The dose prescribed was 50 Gy in 25 fractions. Any FDG-avid areas or regions of particular concern for residual disease were given a simultaneous boost to 60 Gy. Nineteen patients received cisplatin/pemetrexed chemotherapy. Kaplan-Meier analysis was used to calculate rates of overall survival (OS), progression-free survival (PFS), and loco-regional control (LRC). Results : The median follow-up was of 27 months. The median OS and PFS were 33 and 29 months, respectively. The median LRC was not reached. The Kaplan-Meier estimates of OS at 2 and 3 years were 70% and 49%, respectively. The estimates of PFS at 2 and 3 years were 65% and 46%, respectively. The estimates of LRC at 2 and 3 years were 68% and 59%, respectively. The predominant pattern of failure was distant: 7 patients developed distant metastases as the first site of relapse, whereas only 3 patients experienced an isolated loco-regional recurrence. No fatal toxicity was reported. Five Grade 2-3 pneumonitis were documented. Conclusions : High dose radiation therapy following radical P/D led to excellent loco-regional control and survival results in MPM patients. A median OS of 33 months and a 3-year OS rate of 49% are among the best observed in recent studies, supporting the idea that this approach represents a concrete therapeutic option for malignant pleural mesothelioma.