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Extrapleural pneumonectomy after accelerated hemithoracic IMRT deemed safe in mesothelioma

SEATTLE — Accelerated induction hemithoracic intensity-modulated radiation therapy, followed by extrapleural pneumonectomy, was safe and well tolerated in patients treated for malignant pleural mesothelioma, according to results presented at the American Association for Thoracic Surgery Annual Meeting.

“Extrapleural pneumonectomy can be done safely, even after hemithoracic radiation therapy,” Marc de Perrot, MD, MSc, of Toronto General Hospital and Princess Margaret Hospital, said during a presentation.

De Perrot and colleagues conducted a prospective, phase 2 trial between November 2008 and October 2014 on 62 patients. All patients received 25 Gy to 30 Gy radiation in five daily fractions during 1 week delivered to the ipsilateral hemithorax by intensity-modulated radiation therapy (IMRT).

Patients had stage I (n = 10), stage II (n = 35) or stage III (n = 11) cancer. The patients primarily underwent diaphragm (n = 61) and pericardium (n = 58) resection as well as posterior pericardium (n = 57) bronchial stump coverage. Twenty-four patients developed grade 3+ complications. Grade 3+ complications decreased from the first 20 patients to the last 42 patients. Forty-five percent of the first 20 patients experienced complications other than atrial fibrillation, while 12% of the last 42 patients experienced other complications.

Treatment-related death occurred in 4.8% of the patients. One patient died of pneumonia in the hospital, a second died of cardiac arrest at home, and the third died of empyema after hospital discharge.

For patients naive to cT1-3N0M0 treatment (n = 56), overall survival was greater at 36 months in epithelial subtypes (76%) vs. biphasic subtypes (29%).

Among the 48% of patients who developed recurrence, most sites involved the contralateral chest (n = 17) and abdomen (n = 16).

“The mid-term results are encouraging for epithelial subtypes, but longer follow-up is required before definitive conclusions can be made,” de Perrot said. “This approach carries risk and should be done in centers with expertise in surgery and hemithoracic radiation for mesothelioma.” – by Ryan McDonald


De Perrot M, et al. Abstract 25. Presented at: the American Association for Thoracic Surgery Annual Meeting; April 25-29, 2015; Seattle.

Disclosure: De Perrot reports no relevant financial disclosures.

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