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Trama A, Proto C, Signorelli D, Garassino MC, Lo Russo G, Ganzinelli M, Prelaj A, Mensi C, Gangemi M, Gennaro V, Chellini E, Caldarella A, Angelillo IF, Ascoli V, Pascucci C, Tagliabue G, Cusimano R, Bella F, Falcini F, Merler E, Masanotti G, Ziino A, Michiara M, Gola G, Storchi C, Mangone L, Vitale MF, Cirilli C, Tumino R, Scuderi T, Fanetti AC, Piffer S, Tiseo M, Gatta G, Botta L. Treatment patterns among patients with malignant pleural mesothelioma: An Italian, population-based nationwide study. Thorac Cancer 2020; 11:1661-1669. [PMID: 32364316 PMCID: PMC7262944 DOI: 10.1111/1759-7714.13456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 02/29/2020] [Indexed: 12/01/2022] Open
Abstract
Background Malignant pleural mesothelioma (MPM) is a rare cancer with a poor prognosis. Centralization of rare cancer in dedicated centers is recommended to ensure expertise, multidisciplinarity and access to innovation. In Italy, expert centers for MPM have not been identified in all regions. We aimed to describe the treatment patterns among MPM patients across different Italian regions and to identify factors associated with the treatment patterns across the regions. Methods We performed an observational study on a random sample of 2026 MPM patients diagnosed in 2003–2008. We included 26 population‐based registries covering 70% of the Italian population. To identify factors associated with treatment patterns, across the different regions, we fitted a multinomial logistic regression model adjusted by age, sex, stage, histology and hospital with thoracic surgical department. Results MPM patients mostly received chemotherapy alone (41%) or no cancer‐directed therapy (36%) especially the older patients. The first course of treatment for MPM patients differed across regions. Patients from Piedmont, Liguria and Campania were more likely to receive no cancer‐directed therapy; those living in Tuscany and Sicily were more likely to get surgery; patients from Marche and Lazio were more likely to receive chemotherapy. These differences were not explained by age, sex, stage, histology and availability of a thoracic surgery department. Conclusions There is limited expertise available and lack of a network able to maximize the expertise available may contribute to explaining the results of our study. Our findings support the need to ensure the appropriate care of all MPM patients in reorganizing the health care services. Key points
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Affiliation(s)
- Annalisa Trama
- Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Diego Signorelli
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Marina C Garassino
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Lo Russo
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Ganzinelli
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Arsela Prelaj
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Carolina Mensi
- COR Lombardy, Epidemiology Unit,Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and University of Milan, Milan, Italy
| | - Manuela Gangemi
- Unit of Cancer Epidemiology, University of Turin and CPO-Piemonte, Turin, Italy
| | - Valerio Gennaro
- COR Liguria, UO Epidemiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisabetta Chellini
- Unit of Occupational & Environmental Epidemiology, Tuscan Occupational Cancer Registry, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Adele Caldarella
- Tuscan Cancer Registry, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Italo F Angelillo
- Department of Experimental Medicine, COR Campania, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Valeria Ascoli
- Department of Radiological Sciences, Oncology and Anatomical Pathology, COR Lazio, University La Sapienza, Rome, Italy
| | - Cristiana Pascucci
- Mesothelioma Marche Registry - COR Marche, School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Italy
| | - Giovanna Tagliabue
- Varese Cancer Registry, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Francesca Bella
- Integrated Cancer Registry of Catania-Messina-Siracusa-Enna, Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuale, Catania, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Forlì, Italy
| | - Enzo Merler
- COR Veneto, Occupational Health Unit, Department of Prevention, Padua, Italy
| | - Giuseppe Masanotti
- Sec. Public Health, Department of Experimental Medicine, COR Umbria, University of Perugia, Perugia, Italy
| | | | | | | | - Cinzia Storchi
- Servizio di Epidemiologia, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lucia Mangone
- Servizio di Epidemiologia, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria F Vitale
- U.O.S.D. Napoli 3 South Cancer Registry, Piazza San Giovanni, Naples, Italy
| | | | - Rosario Tumino
- Cancer Registry and Histopathology Deaprtment, COR Sicily, 'Civic -M.P. Arezzo' Hospital, Ragusa, Italy
| | | | | | - Silvano Piffer
- Trento Cancer Registry, Servizio Epidemiologia Clinica e Valutativa, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Marcello Tiseo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Gemma Gatta
- Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Botta
- Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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- Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
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Metintas S, Ak G, Metintas M. A review of the cohorts with environmental and occupational mineral fiber exposure. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2018; 74:76-84. [PMID: 29677456 DOI: 10.1080/19338244.2018.1467873] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/28/2018] [Accepted: 04/17/2018] [Indexed: 06/08/2023]
Abstract
The aim of the study was to examine factors associated with Malignant Mesothelioma (MM) incidence rate of the groups with occupational asbestos and environmental asbestos or erionite exposure in rural area. In this ecological study, a total of 21 cohort datasets (8 environmental and 13 occupational) were evaluated. Data were analyzed using a multiple linear regression analysis model. In environmental cohorts, the risk of MM incidence was higher in women and people exposed to erionite. In this cohort, the incidence rate of MM increased as the median exposure time increased, while the incidence decreased as the median cumulative exposure dose increased. In occupational cohorts, the incidence rate of MM was positively correlated with the median cumulative exposure dose. The risk of mesothelioma was lower in those exposed to tremolite than others. Environmental asbestos exposure is as important as occupational exposure to develop MM, and it has its own unique exposure features on the risk of MM.
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Affiliation(s)
- Selma Metintas
- a Lung and Pleural Cancers Research and Clinical Center , Eskisehir Osmangazi University , Eskisehir , Turkey
- b Medical Faculty, Department of Public Health , Eskisehir Osmangazi University , Eskisehir , Turkey
| | - Guntulu Ak
- a Lung and Pleural Cancers Research and Clinical Center , Eskisehir Osmangazi University , Eskisehir , Turkey
- c Medical Faculty, Department of Chest Diseases , Eskisehir Osmangazi University , Eskisehir , Turkey
| | - Muzaffer Metintas
- a Lung and Pleural Cancers Research and Clinical Center , Eskisehir Osmangazi University , Eskisehir , Turkey
- c Medical Faculty, Department of Chest Diseases , Eskisehir Osmangazi University , Eskisehir , Turkey
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Barbieri PG, Marinaccio A, Ferrante P, Scarselli A, Pinelli V, Tassi G. Effects of Combined Therapies on the Survival of Pleural Mesothelioma Patients Treated in Brescia, 1982–2006. TUMORI JOURNAL 2018; 98:215-9. [DOI: 10.1177/030089161209800206] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background During the 1990's, the traditional unimodal treatments (surgery, radiotherapy, chemotherapy, immunotherapy) for malignant pleural mesothelioma started to be combined in bimodal or multimodal strategies. However, recent population-based analyses of the survival of patients with malignant pleural mesothelioma indicate that even these treatments have not led to significant improvements in prognosis, which remains very poor. The present study assessed the survival of patients given combined treatments and multimodal therapies in a specialized hospital department. Methods The study population comprised 530 patients diagnosed with malignant pleural mesothelioma from 1982 to 2006: 343 of them were residents in the province of Brescia (Lombardy, Northern Italy) and 187 were residents outside the province, with a follow-up to 31 December 2009. Kaplan-Meier survival analyses and Cox proportional risks model were used to test sex, age at diagnosis, histological type and treatments, as prognostic factors. Results The estimated median survival for the whole group of patients was 317 days (257 for residents and 398 for non-residents), and respectively 310 and 340 days in the groups diagnosed in the periods 1982–2000 and 2001–2006. Multivariate analysis confirmed that the prognosis was better for younger patients and cases of epithelioid type malignant pleural mesothelioma, whereas for patients receiving any single treatment the prognosis was not significantly better than for those given palliative care alone. However, patients receiving combined treatments or the multimodality approach had significantly longer median survival and the relative risk of death was respectively 0.57 and 0.61 compared to untreated patients (or those only given symptomatic therapy). Conclusions This is the first study in Italy to assess the effectiveness of different treatment approaches in a significant number of patients treated in one hospital. Further studies are needed to confirm the improvement in prognosis – even if modest – on larger numbers of patients and taking into account the different stages of the disease.
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Affiliation(s)
| | - Alessandro Marinaccio
- Department of Occupational Medicine, Epidemiology Unit, Workers’ Compensation Authority (INAIL), ex-ISPESL research area
| | - Pierpaolo Ferrante
- Department of Occupational Medicine, Epidemiology Unit, Workers’ Compensation Authority (INAIL), ex-ISPESL research area
| | - Alberto Scarselli
- Department of Occupational Medicine, Epidemiology Unit, Workers’ Compensation Authority (INAIL), ex-ISPESL research area
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Lee H, Zeng J, Bowen SR, Rengan R. Proton Therapy for Malignant Pleural Mesothelioma: A Three Case Series Describing the Clinical and Dosimetric Advantages of Proton-Based Therapy. Cureus 2017; 9:e1705. [PMID: 29159011 PMCID: PMC5690429 DOI: 10.7759/cureus.1705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is a malignancy of the pleural cavity that typically presents at an advanced stage. Due to its large, circumferential clinical target volume (CTV) and proximity to major structures, including the heart and contralateral lung, delivering hemithoracic intensity-modulated radiotherapy (IMRT) with photon therapy to achieve loco-regional control following macroscopic complete resection is challenging. Intensity-modulated proton therapy (IMPT) has been shown to be a method for achieving higher therapeutic doses while limiting exposure to organs at risk (OARs), but patient outcomes after treatment have yet to be reported. We present three patients who received IMPT to 54 Gy after extrapleural pneumonectomy (EPP), with two patients receiving boosts to 66 and 60 Gy. All three tolerated treatment well and received doses to OARs markedly lower than those seen in comparison volumetric-modulated arc therapy (VMAT) IMRT photon plans. Radiation pneumonitis, a highly morbid and potentially fatal toxicity in patients receiving thoracic radiotherapy, was not observed even with boost treatments. In practice, IMPT appears to match dosimetric predictions as a feasible and safer alternative to photon IMRT-based radiotherapy.
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Affiliation(s)
- Howard Lee
- School of Medicine, Duke University School of Medicine
| | - Jing Zeng
- Radiation Oncology, University of Washington School of Medicine
| | - Stephen R Bowen
- Radiation Oncology, University of Washington School of Medicine
| | - Ramesh Rengan
- Radiation Oncology, University of Washington School of Medicine
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Ascoli V, Minelli G, Cozzi I, Romeo E, Carnovale Scalzo C, Ancona L, Forastiere F. Pathology reporting of malignant pleural mesothelioma first diagnosis: A population-based approach. Pathol Res Pract 2016; 212:886-892. [PMID: 27485167 DOI: 10.1016/j.prp.2016.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 07/01/2016] [Accepted: 07/19/2016] [Indexed: 10/21/2022]
Abstract
Accurate pathologic diagnosis and reporting in malignant pleural mesothelioma are essential for clinical care, and cancer registration. Practical guidelines for pathologists are provided in publications and textbooks but it is unclear how these recommendations are applied in routine practice. We investigated the characteristics of pathology reports, and the extent to which they meet guideline standards. We reviewed 819 pathology reports relating to a first diagnosis of malignant pleural mesothelioma. Data sources were a regional section of the Italian network of the Mesothelioma Registry (2001-2014) and a pathology archive (1990-2000). We evaluated tumor characteristics, the diagnosis field including terminology and immunohistochemistry (IHC) workup, and report completeness (the proportion of items recorded). We investigated also two IHC panels identified by the most used markers in current practical guidelines, one best suited for epithelioid mesotheliomas (combinations of at least 2 positive and at least 2 negative mesothelioma markers) and the other best suited for sarcomatoid mesotheliomas (positive mesothelioma markers plus cytokeratins). Reports (753 histology, 66 cytology, IHC-confirmed 86%) were 74% complete and always narrative. Missing data were related to clinical history (76%), tumor laterality (61%), specimen size (38%), and histological subtype (23%). The proportion of cases with IHC was higher for epithelioid (90%) than sarcomatoid mesothelioma (87%). Compliance to IHC recommendations was higher for epithelioid (59%) than sarcomatoid mesothelioma (11%). The mean number of stains was significantly higher for sarcomatoid than epithelioid mesothelioma (p<0.000; Kruskal-Wallis test). Our findings show that although guidelines are designed to improve actual reporting practices, there is ample room for improvement in their application to standardize the diagnosis of mesothelioma. Synoptic pathology reporting needs to be implemented to better utilize pathology information.
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Affiliation(s)
- Valeria Ascoli
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University, Viale Regina Elena, 324, 00161 Rome, Italy.
| | - Giada Minelli
- Unit of Statistics, Italy's Institute of Public Health (Istituto Superiore di Sanità), Viale Regina Elena, 299, 00161 Rome, Italy.
| | - Ilaria Cozzi
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147 Rome, Italy.
| | - Elisa Romeo
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147 Rome, Italy.
| | - Caterina Carnovale Scalzo
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147 Rome, Italy.
| | - Laura Ancona
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147 Rome, Italy.
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147 Rome, Italy.
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Novello S, Pinto C, Torri V, Porcu L, Di Maio M, Tiseo M, Ceresoli G, Magnani C, Silvestri S, Veltri A, Papotti M, Rossi G, Ricardi U, Trodella L, Rea F, Facciolo F, Granieri A, Zagonel V, Scagliotti G. The Third Italian Consensus Conference for Malignant Pleural Mesothelioma: State of the art and recommendations. Crit Rev Oncol Hematol 2016; 104:9-20. [PMID: 27286698 DOI: 10.1016/j.critrevonc.2016.05.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 03/17/2016] [Accepted: 05/10/2016] [Indexed: 11/26/2022] Open
Abstract
Malignant Pleural Mesothelioma (MPM) remains a relevant public health issue, and asbestos exposure is the most relevant risk factor. The incidence has considerably and constantly increased over the past two decades in the industrialized countries and is expected to peak in 2020-2025. In Italy, a standardized-rate incidence in 2011 among men was 3.5 and 1.25 per 100,000 in men and women, respectively, and wide differences are noted among different geographic areas. The disease remains challenging in terms of diagnosis, staging and treatment and an optimal strategy has not yet been clearly defined. The Third Italian Multidisciplinary Consensus Conference on Malignant Pleural Mesothelioma was held in Bari (Italy) in January 30-31, 2015. This Consensus has provided updated recommendations on the MPM management for health institutions, clinicians and patients.
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Affiliation(s)
- S Novello
- Department of Oncology, University of Turin, Italy.
| | - C Pinto
- Medical Oncology Unit, IRCCS-Arciospedale Santa Maria Nuova, Reggio Emilia, Italy
| | - V Torri
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - L Porcu
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - M Di Maio
- Department of Oncology, University of Turin, Italy
| | - M Tiseo
- Division of Medical Oncology, Azienda Ospedaliera Universitaria di Parma, Italy
| | - G Ceresoli
- Thoracic Oncology Unit, Humanitas Gavazzeni, Bergamo, Italy
| | - C Magnani
- Cancer Epidemiology, University of Eastern Piedmont and CPO-Piemonte, Novara, Italy
| | - S Silvestri
- Istituto per lo Studio e la Prevenzione Oncologica, Florence, Italy
| | - A Veltri
- Department of Oncology, University of Turin, Italy
| | - M Papotti
- Department of Oncology, University of Turin, Italy
| | - G Rossi
- Ospedale Policlinico, Division of Human Pathology, Modena, Italy
| | - U Ricardi
- Department of Oncology, University of Turin, Italy
| | - L Trodella
- Department of Radiotherapy, Campus Bio-Medico University, Rome, Italy
| | - F Rea
- Azienda Ospedaliera, Division of Thoracic Surgery, Padua, Italy
| | - F Facciolo
- Regina Elena Cancer Institute, Division of Thoracic Surgery, Rome, Italy
| | - A Granieri
- University of Torino, Department of Psychology, Italy
| | - V Zagonel
- Veneto Oncology Institute, IRCCS Padova, Italy
| | - G Scagliotti
- Department of Oncology, University of Turin, Italy
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8
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van Zandwijk N. Clinical practice guidelines for malignant pleural mesothelioma. J Thorac Dis 2014; 5:724-5. [PMID: 24409346 DOI: 10.3978/j.issn.2072-1439.2013.12.50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 12/28/2013] [Indexed: 11/14/2022]
Affiliation(s)
- Nico van Zandwijk
- Asbestos Diseases Research Institute, Gate 3, Hospital Rd, Concord, NSW 2139, Australia
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van Zandwijk N, Clarke C, Henderson D, Musk AW, Fong K, Nowak A, Loneragan R, McCaughan B, Boyer M, Feigen M, Currow D, Schofield P, Nick Pavlakis BI, McLean J, Marshall H, Leong S, Keena V, Penman A. Guidelines for the diagnosis and treatment of malignant pleural mesothelioma. J Thorac Dis 2013; 5:E254-307. [PMID: 24416529 PMCID: PMC3886874 DOI: 10.3978/j.issn.2072-1439.2013.11.28] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 11/25/2013] [Indexed: 12/24/2022]
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10
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Amichetti M, Lorentini S, Tonoli S, Magrini SM. Role of new radiation techniques in the treatment of pleural mesothelioma. Thorac Cancer 2013; 4:219-228. [PMID: 28920252 DOI: 10.1111/1759-7714.12008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 10/29/2012] [Indexed: 11/30/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is an aggressive neoplasm arising from the surface serosal cells of the pleural cavity. Surgery remains the main therapeutic standard in the treatment of MPM with the goal of complete gross cytoreduction of the tumor. Because MPM is a diffuse disease affecting the entire mesothelial lining of the hemithorax, surgery alone can rarely achieve adequate tumor-free resection margins. The surgical choices are pleurectomy/decortication (P/D) or extrapleural pneumonectomy (EPP). Radiotherapy (RT) is usually applied postoperatively with the aim to improve local control. However, the efficacy of RT is limited by the large volume of the target to be irradiated (tumor and pleural cavity) and the radiosensitivity of the nearby organs (heart, liver, lung, spinal cord, and esophagus). These factors have historically limited the effective radiation doses that can be given to the patient. There is no role for radical RT alone, but the role of RT as part of multimodality therapy is discussed. After EPP adjuvant RT to the entire hemithorax can reduce the recurrence rate and is well tolerated if strict limits to the dose to contralateral lung are applied: the V20 and V5 (the percent volume of the lung receiving more than 20Gy and 5Gy of radiation) correlate with increased lung toxicity. The use of modern sophisticated techniques allows good target coverage, more conformal high dose delivery, and clinically relevant normal tissue sparing.
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Affiliation(s)
- Maurizio Amichetti
- ATreP - Provincial Agency for Proton Therapy and Proton Therapy Unit, S. Chiara Hospital, Trento, Italy
| | - Stefano Lorentini
- ATreP - Provincial Agency for Proton Therapy and Proton Therapy Unit, S. Chiara Hospital, Trento, Italy
| | - Sandro Tonoli
- Department of Radiation Oncology, Spedali Civili di Brescia, Brescia, Italy
| | - Stefano Maria Magrini
- Department of Radiation Oncology, Spedali Civili di Brescia, Brescia, Italy.,Faculty of Medicine, University of Brescia, Brescia, Italy
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Second Italian Consensus Conference on Malignant Pleural Mesothelioma: State of the art and recommendations. Cancer Treat Rev 2013; 39:328-39. [DOI: 10.1016/j.ctrv.2012.11.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 11/08/2012] [Accepted: 11/13/2012] [Indexed: 10/27/2022]
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Astoul P, Roca E, Galateau-Salle F, Scherpereel A. Malignant Pleural Mesothelioma: From the Bench to the Bedside. Respiration 2012; 83:481-93. [DOI: 10.1159/000339259] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Lorentini S, Amichetti M, Spiazzi L, Tonoli S, Magrini SM, Fellin F, Schwarz M. Adjuvant intensity-modulated proton therapy in malignant pleural mesothelioma. A comparison with intensity-modulated radiotherapy and a spot size variation assessment. Strahlenther Onkol 2012; 188:216-25. [PMID: 22318326 DOI: 10.1007/s00066-011-0038-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 10/04/2011] [Indexed: 12/25/2022]
Abstract
PURPOSE Intensity-modulated radiation therapy (IMRT) is the state-of-the-art treatment for patients with malignant pleural mesothelioma (MPM). The goal of this work was to assess whether intensity-modulated proton therapy (IMPT) could further improve the dosimetric results allowed by IMRT. PATIENTS AND METHODS We re-planned 7 MPM cases using both photons and protons, by carrying out IMRT and IMPT plans. For both techniques, conventional dose comparisons and normal tissue complication probability (NTCP) analysis were performed. In 3 cases, additional IMPT plans were generated with different beam dimensions. RESULTS IMPT allowed a slight improvement in target coverage and clear advantages in dose conformity (p < 0.001) and dose homogeneity (p = 0.01). Better organ at risk (OAR) sparing was obtained with IMPT, in particular for the liver (D(mean) reduction of 9.5 Gy, p = 0.001) and ipsilateral kidney (V(20) reduction of 58%, p = 0.001), together with a very large reduction of mean dose for the contralateral lung (0.2 Gy vs 6.1 Gy, p = 0.0001). NTCP values for the liver showed a systematic superiority of IMPT with respect to IMRT for both the esophagus (average NTCP 14% vs. 30.5%) and the ipsilateral kidney (p = 0.001). Concerning plans obtained with different spot dimensions, a slight loss of target coverage was observed along with sigma increase, while maintaining OAR irradiation always under planning constraints. CONCLUSION Results suggest that IMPT allows better OAR sparing with respect to IMRT, mainly for the liver, ipsilateral kidney, and contralateral lung. The use of a spot dimension larger than 3 × 3 mm (up to 9 × 9 mm) does not compromise dosimetric results and allows a shorter delivery time.
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Affiliation(s)
- S Lorentini
- ATreP - Agenzia Provinciale per la Protonterapia, Via F.lli Perini, 181, 38122, Trento, Italy
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Tonoli S, Vitali P, Scotti V, Bertoni F, Spiazzi L, Ghedi B, Buonamici FB, Marrazzo L, Guidi G, Meattini I, Bastiani P, Amichetti M, Schwarz M, Magrini SM. Adjuvant radiotherapy after extrapleural pneumonectomy for mesothelioma. Prospective analysis of a multi-institutional series. Radiother Oncol 2011; 101:311-5. [PMID: 22079529 DOI: 10.1016/j.radonc.2011.09.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 09/14/2011] [Accepted: 09/20/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate survival, locoregional control and toxicity in a series of 56 mesothelioma patients treated from May 2005 to May 2010 with post-operative radiotherapy after extrapleural pneumonectomy (EPP) in three Italian Institutions (Brescia, Florence, and Modena). MATERIAL AND METHODS Fifty-six patients treated with adjuvant radiotherapy (RT) after EPP were analyzed. Four patients were treated with 3DCRT, 50 with IMRT and two with helical tomotherapy. Forty-five to 50 Gy in 25 fractions were given to the affected hemithorax and to ipsilateral mediastinum, with a simultaneous integrated boost to the sites of microscopically involved margins up to 60 Gy in 20/56 cases. RESULTS Three year locoregional control (LRC), distant metastasis free (DMF), disease free (DF), disease specific (DSS) and overall survival (OS) rates are 90%, 66%, 57%, 62%, and 60%, respectively. CONCLUSION Postoperative RT with modern techniques is an effective method to obtain excellent local control and cure rates in mesothelioma patients submitted to EPP.
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Affiliation(s)
- Sandro Tonoli
- Department of Radiation Oncology, Brescia University, Italy
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