Trimodality therapy of malignant pleural mesothelioma with helical tomotherapy.

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Northern Clinics of Istanbul Pub Date : 2023-01-01 DOI:10.14744/nci.2023.53896

Hazan Ozyurt, Sevim Ozdemir, Bedriye Dogan, Gun Gunalp, Ayse Sevgi Ozden

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Abstract

Objective: The purpose of this study was to determine the efficacy and tolerability of hemithoracic radiotherapy implemented with helical tomotherapy (HTT) in malignant pleural mesothelioma (MPM) patients.

Methods: Between October 2018 and December 2020, data from 11 MPM patients who received trimodality therapy, including lung-sparing surgery (pleurectomy-decortication, P/D), adjuvant chemotherapy (cisplatin+ pemetrexed), and radiotherapy, were retrospectively reviewed. HTT was used to deliver a total of 30 Gy, 50-54 Gy or 59.4-60 Gy to R2 disease with 1.8-2 Gy daily doses. Descriptive data are presented in number (percentage) or median (minimum- maximum). The Kaplan-Meier method was used to calculate survival data. In patients with toxicities, the risk organ doses were compared using the Mann-Whitney U test.

Results: The median follow-up was 20.5 (12-30) months. Two-year local control, disease-free, and overall survival rates were 48.5%, 49%, and 77.9%, respectively. The median prescribed dose for planning target volume (PTV) was 50.4±8.7 (30-60) Gy. Mean dose (D_mean) of total lung was 19.9±6 (10.4-26) Gy; the V20 (%) of ipsilateral and contralateral lungs were 89.±11.2 (62.7-100) and 0.7±2.1 (0.49-5.9), respectively. Esophageal D_mean and maximum doses (D_max) were found as 21.7±8.4 (7.4-34) and 53.1±10.4 (25.4-64.4) Gy, respectively. V30 (%) and Dmean of heart were 22.3%±13.4% (3.9-47) and 21±5.7 (10.8-29.3) Gy, respectively. D_max of medulla spinalis (MS) was 38.6± 1.3 (13.7-48) Gy. Grade 1-2 radiation pneumonitis (RP) developed in 4 (36.4%) and esophagitis in 2 (18.2%) patients. RP was found to be associated with MS and esophageal doses (p<0.05). Myelitis was diagnosed in 1 (9.1%) patient (MS D_max: 29 Gy).

Conclusion: HTT can be used as part of trimodality therapy for MPM patients with acceptable toxicities. MS and esophageal doses should be considered for radiation pneumonitis risk, and new dose constraints for these organs should be defined.

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螺旋断层治疗恶性胸膜间皮瘤的三合一治疗。

目的:本研究的目的是确定螺旋断层治疗(HTT)半胸放疗对恶性胸膜间皮瘤(MPM)的疗效和耐受性。方法:回顾性分析2018年10月至2020年12月期间11例MPM患者接受三模式治疗的数据，包括保肺手术(胸膜切除-去皮术，P/D)、辅助化疗(顺铂+培美曲塞)和放疗。HTT以每日1.8-2 Gy的剂量向R2疾病提供总计30 Gy、50-54 Gy或59.4-60 Gy的剂量。描述性数据以数量(百分比)或中位数(最小-最大)表示。采用Kaplan-Meier法计算生存数据。对于有毒性的患者，使用Mann-Whitney U试验比较危险器官剂量。结果:中位随访时间为20.5(12-30)个月。两年局部控制率、无病生存率和总生存率分别为48.5%、49%和77.9%。计划靶体积(PTV)的中位处方剂量为50.4±8.7 (30-60)Gy。全肺平均剂量(Dmean) 19.9±6 (10.4-26)Gy;同侧肺V20(%)为89±11.2(62.7 ~ 100)，对侧肺V20(%)为0.7±2.1(0.49 ~ 5.9)。食道平均剂量和最大剂量(Dmax)分别为21.7±8.4 (7.4-34)Gy和53.1±10.4 (25.4-64.4)Gy。心脏V30(%)和Dmean分别为22.3%±13.4%(3.9 ~ 47)和21±5.7 (10.8 ~ 29.3)Gy。脊髓髓质(MS) Dmax为38.6±1.3 (13.7-48)Gy。4例(36.4%)患者发生1-2级放射性肺炎(RP)， 2例(18.2%)患者发生食管炎。RP与MS和食道剂量相关(pmax: 29 Gy)。结论:HTT可作为毒性可接受的MPM患者三联疗法的一部分。放射性肺炎的风险应考虑MS和食道剂量，并应确定这些器官的新剂量限制。

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