Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/11289
Title: Establishing locoregional control of malignant pleural mesothelioma using high-dose radiotherapy and (18) F-FDG PET/CT scan correlation.
Authors: Feigen, Malcolm;Lee, Sze Ting;Lawford, Catherine;Churcher, Katheryn;Zupan, Eddy;Scott, Andrew M;Hamilton, Christopher S
Affiliation: Austin Health Radiation Oncology Centre, Heidelberg West Centre for PET Ludwig Institute for Cancer Research Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Victoria, Australia. malcolm.feigen@austin.org.au
Issue Date: 1-Jun-2011
Citation: Journal of Medical Imaging and Radiation Oncology; 55(3): 320-32
Abstract: The management of malignant pleural mesothelioma represents one of the most challenging issues in oncology, as there is no proven long-term benefit from surgery, radiotherapy or chemotherapy alone or in combination. Locoregional progression remains the major cause of death, but radical surgical resection may produce major postoperative morbidity. While radical or postoperative radiotherapy using conventional techniques has resulted in severe toxicity with no impact on survival, recent advances in radiotherapy delivery may be more effective.We treated patients with locally advanced mesothelioma whose tumours had been sub optimally resected with high-dose three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT) to large volumes of one hemithorax, using CT and positron emission tomography (PET) scan-based treatment planning. Clinical outcomes were assessed by determining patterns of failure and metabolic changes in total glycolytic volume (TGV) between pre- and post-irradiation( 18) F-FDG PET/CT scans and by recording acute and late toxicity grades.Fourteen patients were analysed with 40 PET scans performed before and up to 4.5years after radiotherapy. Eleven patients had pleurectomy/decortications, one had an extrapleural pneumonectomy and two had no surgery. Four patients who received chemotherapy had all progressed prior to radiotherapy. After radiotherapy, the in-field local control rate was 71%. No progression occurred in two patients, one was salvaged with further radiotherapy to a new site, four recurred inside the irradiated volume all with concurrent distant metastases and the other seven had distant metastases only. The TGVs were reduced by an average of 67% (range 12-100%) after doses of 45 to 60Gy to part or all of one hemithorax. There were no serious treatment-related toxicities. Median survival was 25months from diagnosis and 17months after starting radiotherapy.We have established that mesothelioma can be locally controlled with high radiation doses using 3DCRT or IMRT, and that strict normal tissue dose constraints have limited radiation toxicities. Radiotherapy should be considered to prevent or delay the local manifestations of progressive disease in suitable patients after surgery including extrapleural pneumonectomy and pleurectomy/decortication. Higher radiation doses may allow more effective palliation.
Internal ID Number: 21696568
URI: http://ahro.austin.org.au/austinjspui/handle/1/11289
DOI: 10.1111/j.1754-9485.2011.02274.x
URL: http://www.ncbi.nlm.nih.gov/pubmed/21696568
Type: Journal Article
Subjects: Adult
Aged
Female
Fluorodeoxyglucose F18.diagnostic use
Humans
Male
Mesothelioma.radiography.radionuclide imaging.radiotherapy
Middle Aged
Pleural Neoplasms.radiography.radionuclide imaging.radiotherapy
Positron-Emission Tomography
Radiopharmaceuticals.diagnostic use
Radiotherapy Dosage
Radiotherapy, Conformal
Radiotherapy, Intensity-Modulated
Tomography, X-Ray Computed
Appears in Collections:Journal articles

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