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Abstract：
OBJECTIVE: To assess the value of radiation therapy (RT) with helical tomotherapy (HT) in the management of locally advanced malignant pleural mesothelioma (MPM) receiving no or lung-sparing surgery.
METHODS: Consecutive MPM cases not undergoing extrapleural pneumonectomy and receiving intensity-modulated (IM) HT were retrospectively evaluated for local control, distant control, progression-free survival (PFS), and overall survival (OS). Impact of age, systemic treatment, RT dose, and recurrence patterns was analyzed by univariate and multivariate analysis. As a secondary endpoint, reported toxicity was assessed.
RESULTS: A total of 34 localized MPM cases undergoing IMHT were identified, of which follow-up data were available for 31 patients. Grade 3 side effects were experienced by 26.7% of patients and there were no grade 4 or 5 events observed. Median PFS was 19 months. Median OS was 20 months and the rates for 1‑ and 2‑year OS were 86.2 and 41.4%, respectively. OS was significantly superior for patients receiving adjuvant chemotherapy (p = 0.008).
CONCLUSIONS: IMHT of locally advanced MPM after lung-sparing surgery is safe and feasible, resulting in satisfactory local control and survival. Adjuvant chemotherapy significantly improves OS. Randomized clinical trials incorporating modern RT techniques as a component of trimodal treatment are warranted to establish an evidence-based standard of care pattern for locally advanced MPM.
METHODS: Consecutive MPM cases not undergoing extrapleural pneumonectomy and receiving intensity-modulated (IM) HT were retrospectively evaluated for local control, distant control, progression-free survival (PFS), and overall survival (OS). Impact of age, systemic treatment, RT dose, and recurrence patterns was analyzed by univariate and multivariate analysis. As a secondary endpoint, reported toxicity was assessed.
RESULTS: A total of 34 localized MPM cases undergoing IMHT were identified, of which follow-up data were available for 31 patients. Grade 3 side effects were experienced by 26.7% of patients and there were no grade 4 or 5 events observed. Median PFS was 19 months. Median OS was 20 months and the rates for 1‑ and 2‑year OS were 86.2 and 41.4%, respectively. OS was significantly superior for patients receiving adjuvant chemotherapy (p = 0.008).
CONCLUSIONS: IMHT of locally advanced MPM after lung-sparing surgery is safe and feasible, resulting in satisfactory local control and survival. Adjuvant chemotherapy significantly improves OS. Randomized clinical trials incorporating modern RT techniques as a component of trimodal treatment are warranted to establish an evidence-based standard of care pattern for locally advanced MPM.
摘要：
目的：评估放疗（RT）和螺旋断层放疗（HT）在不接受或保留肺手术的局部晚期恶性胸膜间皮瘤（MPM）治疗中的价值。
方法：回顾性评估未接受胸膜外全肺切除术和接受调强（IM）HT的连续MPM病例的局部控制，远程控制,无进展生存期（PFS），总生存率（OS）。年龄的影响,全身治疗,RT剂量，复发模式进行单因素和多因素分析。作为次要端点，报告的毒性进行了评估。
结果：共发现34例接受IMHT的局部MPM病例，其中有31例患者的随访数据.26.7％的患者经历了3级副作用，没有观察到4级或5级事件。PFS中位数为19个月。中位OS为20个月，1年和2年OS率为86.2％和41.4％，分别。接受辅助化疗的患者的OS明显优于（p=0.008）。
结论：保留肺手术后局部晚期MPM的IMHT是安全可行的，导致令人满意的局部控制和生存。辅助化疗显著改善OS。有必要将现代RT技术作为三模态治疗组成部分的随机临床试验，以建立基于证据的局部晚期MPM护理模式标准。
方法：回顾性评估未接受胸膜外全肺切除术和接受调强（IM）HT的连续MPM病例的局部控制，远程控制,无进展生存期（PFS），总生存率（OS）。年龄的影响,全身治疗,RT剂量，复发模式进行单因素和多因素分析。作为次要端点，报告的毒性进行了评估。
结果：共发现34例接受IMHT的局部MPM病例，其中有31例患者的随访数据.26.7％的患者经历了3级副作用，没有观察到4级或5级事件。PFS中位数为19个月。中位OS为20个月，1年和2年OS率为86.2％和41.4％，分别。接受辅助化疗的患者的OS明显优于（p=0.008）。
结论：保留肺手术后局部晚期MPM的IMHT是安全可行的，导致令人满意的局部控制和生存。辅助化疗显著改善OS。有必要将现代RT技术作为三模态治疗组成部分的随机临床试验，以建立基于证据的局部晚期MPM护理模式标准。
