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Dejanovic D, Specht L, Czyzewska D, Kiil Berthelsen A, Loft A. Response Evaluation Following Radiation Therapy With 18F-FDG PET/CT: Common Variants of Radiation-Induced Changes and Potential Pitfalls. Semin Nucl Med 2022; 52:681-706. [PMID: 35835618 DOI: 10.1053/j.semnuclmed.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 11/11/2022]
Abstract
Radiation therapy (RT) is one of the cornerstones in cancer treatment and approximately half of all patients will receive some form of RT during the course of their cancer management. Response evaluation after RT and follow-up imaging with 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) can be complicated by RT-induced acute, chronic or consequential effects. There is a general consensus that 18F-FDG PET/CT for response evaluation should be delayed for 12 weeks after completing RT to minimize the risk of false-positive findings. Radiation-induced late side effects in normal tissue can take years to develop and eventually cause symptoms that on imaging can potentially mimic recurrent disease. Imaging findings in radiation induced injuries depend on the normal tissue included in the irradiated volume and the radiation therapy regime including the total dose delivered, dose per fraction and treatment schedule. The intent for radiation therapy should be taken in consideration when evaluating the response on imaging, that is palliative vs curative or neoadjuvant vs adjuvant RT. Imaging findings can further be distorted by altered anatomy and sequelae following surgery within the radiation field. An awareness of common PET/CT-induced changes/injuries is essential when interpreting 18F-FDG PET/CT as well as obtaining a complete medical history, as patients are occasionally scanned for an unrelated cause to previously RT treated malignancy. In addition, secondary malignancies due to carcinogenic effects of radiation exposure in long-term cancer survivors should not be overlooked. 18F-FDG PET/CT can be very useful in response evaluation and follow-up in patients treated with RT, however, variants and pitfalls are common and it is important to remember that radiation-induced injury is often a diagnosis of exclusion.
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Affiliation(s)
- Danijela Dejanovic
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Lena Specht
- Department of Oncology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Dorota Czyzewska
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Kiil Berthelsen
- Department of Oncology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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2
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Patel R, Ludmir EB, Miccio JA, Menon H, Barsky AR, Mesko SM, Kodali M, Lautenschlaeger T, Adeberg S, Simone CB, Verma V. Disease-Related Outcomes and Toxicities of Intensity Modulated Radiation Therapy After Lung-Sparing Pleurectomy for Malignant Pleural Mesothelioma: A Systematic Review. Pract Radiat Oncol 2020; 10:423-433. [PMID: 32088429 DOI: 10.1016/j.prro.2020.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/06/2020] [Accepted: 02/08/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE This review explores the use of intensity modulated radiation therapy (IMRT) after lung-sparing surgery in malignant pleural mesothelioma (MPM). Because severe toxicities have been documented after radiation therapy for MPM, its use remains controversial, especially as modern surgical management has shifted toward lung-sparing pleurectomy/decortication. IMRT is an advanced technique that may allow for safer radiation therapy delivery, but there remains limited data (including no summative data) to support this notion. METHODS AND MATERIALS We performed a systematic review evaluating the safety and efficacy of post-pleurectomy IMRT (P-IMRT). A systematic review of PubMed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted for publications of all dates that specifically reported clinical outcomes and/or toxicities of P-IMRT in patients with MPM. Ten original studies were included in this review. RESULTS The incidence of grade 3 pneumonitis ranged from 0% to 16%, with all but 2 studies reporting rates below 9%. Grade 4 and 5 pneumonitis were observed in less than 1.5% of cases, except in one publication that used hypofractionated radiation therapy to doses >60 Gy. Crude local failure rates ranged from 19% to 60%, median progression free survival ranged from 12 to 16 months, and median overall survival ranged from 19 to 28 months. CONCLUSIONS P-IMRT produces relatively few higher-grade toxicities and has reasonable disease-related outcomes, especially when delivered using conventionally fractionated regimens to doses of 45 to 54 Gy and exercising careful attention to dose constraints during treatment planning. IMRT can thus be considered in well-selected patients in whom adequate survival after pleurectomy is expected. These data also support the initiation of the phase III NRG-LU006 trial of extended pleurectomy/decortication and chemotherapy with or without IMRT.
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Affiliation(s)
| | - Ethan B Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joseph A Miccio
- Department of Therapeutic Radiology, Yale University, New Haven, Connecticut
| | - Hari Menon
- University of Arizona College of Medicine, Phoenix, Phoenix, Arizona
| | - Andrew R Barsky
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shane M Mesko
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Manya Kodali
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Tim Lautenschlaeger
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York
| | - Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, Pennsylvania.
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3
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Gomez DR, Rimner A, Simone CB, Cho BCJ, de Perrot M, Adjei AA, Bueno R, Gill RR, Harpole DH, Hesdorffer M, Hirsch FR, Jackson AA, Pass HI, Rice DC, Rusch VW, Tsao AS, Yorke E, Rosenzweig K. The Use of Radiation Therapy for the Treatment of Malignant Pleural Mesothelioma: Expert Opinion from the National Cancer Institute Thoracic Malignancy Steering Committee, International Association for the Study of Lung Cancer, and Mesothelioma Applied Research Foundation. J Thorac Oncol 2019; 14:1172-1183. [PMID: 31125736 DOI: 10.1016/j.jtho.2019.03.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 03/28/2019] [Accepted: 03/28/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Detailed guidelines regarding the use of radiation therapy for malignant pleural mesothelioma (MPM) are currently lacking because of the rarity of the disease, the wide spectrum of clinical presentations, and the paucity of high-level data on individual treatment approaches. METHODS In March 2017, a multidisciplinary meeting of mesothelioma experts was cosponsored by the U.S. National Cancer Institute, International Association for the Study of Lung Cancer Research, and Mesothelioma Applied Research Foundation. Among the outcomes of this conference was the foundation of detailed, multidisciplinary consensus guidelines. RESULTS Here we present consensus recommendations on the use of radiation therapy for MPM in three discrete scenarios: (1) hemithoracic radiation therapy to be used before or after extrapleural pneumonectomy; (2) hemithoracic radiation to be used as an adjuvant to lung-sparing procedures (i.e., without pneumonectomy); and (3) palliative radiation therapy for focal symptoms caused by the disease. We discuss appropriate simulation techniques, treatment volumes, dose fractionation regimens, and normal tissue constraints. We also assess the role of particle beam therapy, specifically, proton beam therapy, for MPM. CONCLUSION The recommendations provided in this consensus statement should serve as important guidelines for developing future clinical trials of treatment approaches for MPM.
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Affiliation(s)
- Daniel R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - B C John Cho
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Marc de Perrot
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Alex A Adjei
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Raphael Bueno
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ritu R Gill
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - David H Harpole
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | | | - Fred R Hirsch
- Department of Medicine, University of Colorado, Denver, Colorado; Department of Pathology, University of Colorado, Denver, Colorado
| | | | - Harvey I Pass
- Department of Cardiothoracic Surgery, New York University School of Medicine, New York, New York
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Valerie W Rusch
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anne S Tsao
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kenneth Rosenzweig
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York
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Computed tomography features of local pleural recurrence in patients with malignant pleural mesothelioma treated with intensity-modulated pleural radiation therapy. Eur Radiol 2019; 29:3696-3704. [PMID: 30689034 DOI: 10.1007/s00330-018-5937-6] [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: 07/31/2018] [Revised: 10/11/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study was conducted in order to describe the computed tomography (CT) features of local pleural recurrence in patients with malignant pleural mesothelioma undergoing intensity-modulated pleural radiation therapy (IMPRINT) as part of multimodality treatment. METHODS In this observational study, 58 patients treated with IMPRINT between September 21, 2004, and December 1, 2014 were included. Baseline and follow-up CT scans were qualitatively assessed. On follow-up scans, pleural thickening was categorized as unchanged, decreased, or new/increased. New/increased pleural abnormality was subcategorized as diffuse smooth pleural thickening, diffuse nodular pleural thickening, focal pleural nodule, or multiple pleural nodules. To identify features more frequently present at the time of local recurrence, follow-up scans with local recurrence were matched to four control scans; exact conditional logistic regression was performed. RESULTS Twenty-one (36%) patients had local pleural recurrence and 20 (34%) patients had nonpleural recurrence; 3 patients had both types of recurrence. The 1-year cumulative incidence rate of local recurrence was 27% (95% confidence interval 15, 39). On follow-up scans, three patterns of pleural abnormality were significantly associated with local recurrence: new/increased multiple pleural nodules (10 (48%) positive scans vs 0 control scans), new/increased diffuse nodular pleural thickening (7 (33%) positive scans vs 1 (1%) control scans), and new/increased focal pleural nodule (3 (14%) positive scans vs 1 (1%) control scan) (p < 0.001 for all). CONCLUSIONS Multiple new/increased pleural nodules are the feature most commonly present at local recurrence following IMPRINT; however, any pattern of increased nodular pleural thickening is suspicious. KEY POINTS • In patients with mesothelioma receiving intensity-modulated pleural radiation as part of multimodality therapy, increasing multiple pleural nodules is the computed tomography feature most commonly present at local recurrence. • In these patients, any CT pattern of increased nodular pleural thickening should be considered suspicious for local recurrence. • The most common sites of nonpleural recurrence were lung parenchyma, thoracic lymph nodes, and peritoneum.
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5
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Radiation Therapy in Mesothelioma. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-52619-5_36-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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6
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Cramer G, Simone CB, Busch TM, Cengel KA. Adjuvant, neoadjuvant, and definitive radiation therapy for malignant pleural mesothelioma. J Thorac Dis 2018; 10:S2565-S2573. [PMID: 30206500 DOI: 10.21037/jtd.2018.07.65] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
While ionizing radiotherapy (RT) can provide durable local control, the relative radiosensitivity of surrounding organs such as the lungs and heart and the distributed nature of the pleura limit the ability to safely deliver RT for patients with malignant pleural mesothelioma (MPM). Recent advances in the technological sophistication of RT planning and delivery devices have resulted in increased spatial control of irradiation dose that has extended the palliative and definitive applications of RT for patients with MPM. This review will outline the logistical, mechanistic and clinical basics of RT and the clinical trials supporting the use of RT in the multidisciplinary care of patients with MPM.
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Affiliation(s)
- Gwendolyn Cramer
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Theresa M Busch
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Keith A Cengel
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
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7
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Pinelopi-Theopisti M, Aikaterini P, Ariadni K, Chrysoula I, Panagiotis P, Martha C. The Place and the Role of Radiation Therapy in the Treatment of Thymic Carcinoma. World J Oncol 2017; 7:95-97. [PMID: 28983372 PMCID: PMC5624649 DOI: 10.14740/wjon972e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2016] [Indexed: 12/02/2022] Open
Abstract
Thymic carcinomas arise from the epithelial cells of the thymus gland and are the most common tumors of the anterior mediastinum despite their overall rarity. Because of their rarity, their treatment remains a challenging topic. Although historically they have been treated surgically, radiation therapy (RT) has an important role either as a definitive or as a postoperative treatment. In this article, we present a review of the current therapies for the thymic carcinomas and try to identify the exact place of the RT in the optimal management of these patients.
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Affiliation(s)
| | - Papadopoulou Aikaterini
- Department of Radiation Oncology, AHEPA Hospital, Aristotle University, Thessaloniki, Greece
| | | | - Iliopoulou Chrysoula
- Department of Radiation Oncology, Cancer Hospital "Theageneio", Thessaloniki, Greece
| | - Pantelis Panagiotis
- Department of Radiation Oncology, Cancer Hospital "Theageneio", Thessaloniki, Greece
| | - Charalambidou Martha
- Department of Radiation Oncology, Cancer Hospital "Theageneio", Thessaloniki, Greece
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8
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Foroudi F, Smith JG, Putt F, Wada M. High-dose palliative radiotherapy for malignant pleural mesothelioma. J Med Imaging Radiat Oncol 2017; 61:797-803. [DOI: 10.1111/1754-9485.12636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/12/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Farshad Foroudi
- Department of Radiation Oncology, Austin Health; Melbourne Victoria Australia
| | | | - Faye Putt
- Department of Radiation Oncology, Austin Health; Melbourne Victoria Australia
| | - Morikatsu Wada
- Department of Radiation Oncology, Austin Health; Melbourne Victoria Australia
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9
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Does selective pleural irradiation of malignant pleural mesothelioma allow radiation dose escalation? Strahlenther Onkol 2017; 193:285-294. [DOI: 10.1007/s00066-017-1108-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 01/27/2017] [Indexed: 12/16/2022]
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10
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Simone CB, Busch TM, Cengel KA. Radiotherapy and Photodynamic Therapy for Malignant Pleural Mesothelioma. ASBESTOS AND MESOTHELIOMA 2017. [DOI: 10.1007/978-3-319-53560-9_14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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11
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Botticella A, Defraene G, Nackaerts K, Deroose CM, Coolen J, Nafteux P, Peeters S, Ricardi U, De Ruysscher D. Optimal gross tumor volume definition in lung-sparing intensity modulated radiotherapy for pleural mesothelioma: an in silico study. Acta Oncol 2016; 55:1450-1455. [PMID: 27732127 DOI: 10.1080/0284186x.2016.1234066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The gross tumor volume (GTV) definition for malignant pleural mesothelioma (MPM) is ill-defined. We therefore investigated which imaging modality is optimal: computed tomography (CT) with intravenous contrast (IVC), positron emission tomography-CT (PET/CT) or magnetic resonance imaging (MRI). MATERIAL AND METHODS Sixteen consecutive patients with untreated stage I-IV MPM were included. Patients with prior pleurodesis were excluded. CT with IVC, 18FDG-PET/CT and MRI (T2 and contrast-enhanced T1) were obtained. CT was rigidly co-registered with PET/CT and with MRI. Three sets of pleural GTVs were defined: GTVCT, GTVCT+PET/CT and GTVCT+MRI. Quantitative and qualitative evaluations of the contoured GTVs were performed. RESULTS Compared to CT-based GTV definition, PET/CT identified additional tumor sites (defined as either separate nodules or greater extent of a known tumor) in 12/16 patients. Compared to either CT or PET/CT, MRI identified additional tumor sites in 15/16 patients (p = .7). The mean GTVCT, GTVCT+PET/CT and GTVCT+MRI [±standard deviation (SD)] were 630.1 cm3 (±302.81), 640.23 cm3 (±302.83) and 660.8 cm3 (±290.8), respectively. Differences in mean volumes were not significant. The mean Jaccard Index was significantly lower in MRI-based contours versus all the others. CONCLUSION As MRI identified additional pleural disease sites in the majority of patients, it may play a role in optimal target volume definition.
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Affiliation(s)
- Angela Botticella
- Department of Oncology, Experimental Radiation Oncology, KU Leuven–University of Leuven, Leuven, Belgium
| | - Gilles Defraene
- Department of Oncology, Experimental Radiation Oncology, KU Leuven–University of Leuven, Leuven, Belgium
| | - Kristiaan Nackaerts
- Respiratory Diseases/Respiratory Oncology Unit, KU Leuven–University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Christophe M. Deroose
- Department Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven–University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Johan Coolen
- Radiology Department, University Hospitals Leuven, Leuven, Belgium
| | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Stephanie Peeters
- Department of Radiation Oncology, KU Leuven–University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - Dirk De Ruysscher
- Department of Radiation Oncology, KU Leuven–University of Leuven, University Hospitals Leuven, Leuven, Belgium
- GROW–School for Oncology and Developmental Biology, Department of Radiation Oncology (MAASTRO clinic), Maastricht University Medical Center, Maastricht, The Netherlands
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12
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Xie C, Gleeson F. The pleura. IMAGING 2016. [DOI: 10.1183/2312508x.10006715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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13
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Cheng L, Tunariu N, Collins DJ, Blackledge MD, Riddell AM, Leach MO, Popat S, Koh DM. Response evaluation in mesothelioma: Beyond RECIST. Lung Cancer 2015; 90:433-41. [PMID: 26443279 DOI: 10.1016/j.lungcan.2015.08.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/05/2015] [Accepted: 08/17/2015] [Indexed: 12/12/2022]
Abstract
Malignant pleural mesothelioma (MPM) typically demonstrates a non-spherical growth pattern, so it is often difficult to accurately categorize change in tumour burden using size-based tumour response criteria (e.g., WHO (World Health Organisation), RECIST (Response Evaluation Criteria in Solid Tumours) and modified RECIST). Functional imaging techniques are applied to derive quantitative measurements of tumours, which reflect particular aspects of the tumour pathophysiology. By quantifying how these measurements change with treatment, it is possible to observe treatment effects. In this review, we survey the existing roles of CT and MRI for the management of MPM, including the currently applied size measurement criteria for the assessment of treatment response. New functional imaging techniques, such as positron emission tomography (PET), diffusion-weighted MRI (DWI) and dynamic contrast-enhanced MRI (DCE-MRI) that may potentially improve the assessment of treatment response will be highlighted and discussed.
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Affiliation(s)
- Lin Cheng
- EPSRC-CR UK Cancer Imaging Centre, Institute of Cancer Research, UK
| | - Nina Tunariu
- EPSRC-CR UK Cancer Imaging Centre, Institute of Cancer Research, UK; Department of Radiology, Royal Marsden Hospital, UK
| | - David J Collins
- EPSRC-CR UK Cancer Imaging Centre, Institute of Cancer Research, UK
| | | | | | - Martin O Leach
- EPSRC-CR UK Cancer Imaging Centre, Institute of Cancer Research, UK
| | - Sanjay Popat
- Department of Medical Oncology, Royal Marsden Hospital, UK
| | - Dow-Mu Koh
- EPSRC-CR UK Cancer Imaging Centre, Institute of Cancer Research, UK; Department of Radiology, Royal Marsden Hospital, UK.
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14
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Wolf AS, Rosenzweig KE, Flores RM. Radiation therapy for malignant pleural mesothelioma. Lung Cancer Manag 2015. [DOI: 10.2217/lmt.15.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Malignant pleural mesothelioma is an aggressive tumor where the ability to control the primary tumor (local control) presents a significant challenge. External beam radiation has the potential to improve local control when following established safe and effective protocols. Radiation is primarily used as adjuvant treatment after extrapleural pneumonectomy or pleurectomy/decortication and as palliative treatment in some cases. The target volume for radiotherapy of malignant pleural mesothelioma can be quite extensive and thus toxicity is its chief limitation.
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Affiliation(s)
- Andrea S Wolf
- Thoracic Surgery Department, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA
| | - Kenneth E Rosenzweig
- Thoracic Surgery Department, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA
| | - Raja M Flores
- Thoracic Surgery Department, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA
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15
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Shaikh F, Rimner A. Optimizing hemithoracic pleural intensity-modulated radiation therapy for malignant pleural mesothelioma. Lung Cancer Manag 2015. [DOI: 10.2217/lmt.15.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The treatment of malignant pleural mesothelioma (MPM) remains challenging. Optimal management for resectable patients involves an aggressive approach, frequently using trimodality therapy. Historically, poor tumor control and profound pulmonary toxicity prevented conventional radiation therapy from being widely used. The advent of intensity-modulated radiation therapy was a major development in the delivery of radiation for MPM in the adjuvant setting, improving target coverage and dose homogeneity while maintaining acceptable toxicity profiles. Nevertheless, there remains a significant risk of severe pulmonary toxicity, ameliorated by careful target delineation, treatment planning and proactive toxicity management. Innovative technology, including arc therapy, simultaneous integrated boosts and proton therapy as well as neodjuvant delivery of radiation followed by pneumonectomy are being actively investigated to improve outcomes in the treatment of MPM.
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Affiliation(s)
- Fauzia Shaikh
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave., NY 10065, USA
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave., NY 10065, USA
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16
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Gomez D, Tsao AS. Local and systemic therapies for malignant pleural mesothelioma. Curr Treat Options Oncol 2015; 15:683-99. [PMID: 25266654 DOI: 10.1007/s11864-014-0314-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OPINION STATEMENT Malignant pleural mesothelioma (MPM) is a challenging disease to treat with median overall survival times ranging between 9-17 months for all stages of disease. Recent clinical trials have improved our understanding of the biology of MPM. However, survival results are still not ideal. For early-stage MPM, patients should be evaluated for trimodality therapy in an experienced cancer center. If treating off-protocol, MPM patients should receive a surgical staging evaluation. The decision to proceed with surgical resection also should be considered after an extensive and thorough pulmonary and cardiac evaluation. If deemed a good surgical candidate, patients should receive surgical resection (pleurectomy/decortication or extrapleural pneumonectomy), adjuvant radiation therapy (hemithoracic external beam or intensity modulated radiation therapy), and either neoadjuvant or adjuvant chemotherapy (cisplatin-pemetrexed for 4 cycles). The optimal precise sequence of the trimodality is unclear and should be decided upon by a multidisciplinary consensus for each individual patient. In general, clinical trial participation should be encouraged. Several trials are currently underway to examine intraoperative therapies, vaccines, immunotherapy additions, and novel radiation therapy techniques. Advances in the field of MPM are reliant on participation in clinical trials and identifying biomarkers that are predictive for response to systemic therapies and prognostic for survival benefit.
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Affiliation(s)
- Daniel Gomez
- Department of Thoracic Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
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17
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Chance WW, Rice DC, Allen PK, Tsao AS, Fontanilla HP, Liao Z, Chang JY, Tang C, Pan HY, Welsh JW, Mehran RJ, Gomez DR. Hemithoracic intensity modulated radiation therapy after pleurectomy/decortication for malignant pleural mesothelioma: toxicity, patterns of failure, and a matched survival analysis. Int J Radiat Oncol Biol Phys 2014; 91:149-56. [PMID: 25442335 DOI: 10.1016/j.ijrobp.2014.08.343] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 08/21/2014] [Accepted: 08/25/2014] [Indexed: 12/23/2022]
Abstract
PURPOSE To investigate safety, efficacy, and recurrence after hemithoracic intensity modulated radiation therapy after pleurectomy/decortication (PD-IMRT) and after extrapleural pneumonectomy (EPP-IMRT). METHODS AND MATERIALS In 2009-2013, 24 patients with mesothelioma underwent PD-IMRT to the involved hemithorax to a dose of 45 Gy, with an optional integrated boost; 22 also received chemotherapy. Toxicity was scored with the Common Terminology Criteria for Adverse Events v4.0. Pulmonary function was compared at baseline, after surgery, and after IMRT. Kaplan-Meier analysis was used to calculate overall survival (OS), progression-free survival (PFS), time to locoregional failure, and time to distant metastasis. Failures were in-field, marginal, or out of field. Outcomes were compared with those of 24 patients, matched for age, nodal status, performance status, and chemotherapy, who had received EPP-IMRT. RESULTS Median follow-up time was 12.2 months. Grade 3 toxicity rates were 8% skin and 8% pulmonary. Pulmonary function declined from baseline to after surgery (by 21% for forced vital capacity, 16% for forced expiratory volume in 1 second, and 19% for lung diffusion of carbon monoxide [P for all = .01]) and declined still further after IMRT (by 31% for forced vital capacity [P=.02], 25% for forced expiratory volume in 1 second [P=.01], and 30% for lung diffusion of carbon monoxide [P=.01]). The OS and PFS rates were 76% and 67%, respectively, at 1 year and 56% and 34% at 2 years. Median OS (28.4 vs 14.2 months, P=.04) and median PFS (16.4 vs 8.2 months, P=.01) favored PD-IMRT versus EPP-IMRT. No differences were found in grade 4-5 toxicity (0 of 24 vs 3 of 24, P=.23), median time to locoregional failure (18.7 months vs not reached, P not calculable), or median time to distant metastasis (18.8 vs 11.8 months, P=.12). CONCLUSIONS Hemithoracic intensity modulated radiation therapy after pleurectomy/decortication produced little high-grade toxicity but led to progressive declines in pulmonary function; OS and PFS were better in PD-IMRT compared with EPP-IMRT.
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Affiliation(s)
- William W Chance
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pamela K Allen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anne S Tsao
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joe Y Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hubert Y Pan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - James W Welsh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel R Gomez
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Fay M, Poole CM, Pratt G. Recent advances in radiotherapy for thoracic tumours. J Thorac Dis 2014; 5 Suppl 5:S551-5. [PMID: 24163747 DOI: 10.3978/j.issn.2072-1439.2013.08.46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 08/19/2013] [Indexed: 01/01/2023]
Abstract
Radiation Oncology technology has continued to advance at a rapid rate and is bringing significant benefits to patients. This review outlines some of the advances in technology and radiotherapy treatment of thoracic cancers including brachytherapy, stereotactic radiotherapy, tomotherapy and intensity modulated radiotherapy. The importance of functional imaging with PET and management of movement are highlighted. Most of the discussion relates to non-small cell lung cancer but management of mesothelioma and small cell lung cancer are also covered. This technology has substantial benefits to patients in terms of decreasing toxicity both in the short and longer term.
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Affiliation(s)
- Michael Fay
- Division of Oncology, Royal Brisbane and Women's Hospital, Queensland Health, Brisbane, Australia; ; School of Medicine, University of Queensland, Brisbane, Australia; ; Visiting Scientist, Preclinical Molecular Imaging, Eberhard Karls Universität Tübingen, Germany
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19
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Komaki R, Gomez DR. Radiotherapy for thymic carcinoma: adjuvant, inductive, and definitive. Front Oncol 2014; 3:330. [PMID: 24455488 PMCID: PMC3887269 DOI: 10.3389/fonc.2013.00330] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 12/25/2013] [Indexed: 12/25/2022] Open
Abstract
Although historically thymoma and thymic carcinoma have been treated surgically, radiation therapy also has an important role, either as postoperative therapy to reduce the risk of mediastinal recurrence or as part of definitive treatment for patients who cannot undergo surgery. Induction chemotherapy and molecular targeted agents may also be appropriate for thymic carcinoma, the behavior of which resembles non-small-cell lung carcinoma more than that of thymoma or invasive thymoma and is increasingly being treated like lung cancer. We present here a review of current therapies for thymic malignancies and briefly discuss the potential benefits from novel technologies for such treatment.
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Affiliation(s)
- Ritsuko Komaki
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Daniel R Gomez
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center , Houston, TX , USA
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20
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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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21
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Rimner A, Rosenzweig KE. Novel radiation therapy approaches in malignant pleural mesothelioma. Ann Cardiothorac Surg 2013; 1:457-61. [PMID: 23977536 DOI: 10.3978/j.issn.2225-319x.2012.10.07] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 10/26/2012] [Indexed: 11/14/2022]
Affiliation(s)
- Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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22
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FDG PET/CT in the Management of Primary Pleural Tumors and Pleural Metastases. AJR Am J Roentgenol 2013; 201:W215-26. [DOI: 10.2214/ajr.13.10572] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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23
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Fuccio C, Spinapolice EG, Ferretti A, Castellucci P, Marzola MC, Trifirò G, Rubello D. ¹⁸F-FDG-PET/CT in malignant mesothelioma. Biomed Pharmacother 2013; 67:539-42. [PMID: 23583476 DOI: 10.1016/j.biopha.2013.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 01/24/2013] [Indexed: 11/30/2022] Open
Abstract
It is well known the useful role of ¹⁸F-FDG-PET/CT for differential diagnosis between benign and malignant disease, for staging, for monitoring response and for prognosis regarding mesothelioma. Recently, literature was enriched with new interesting studies regarding the potential applications of ¹⁸F-FDG-PET/CT in this field. The purpose of this review is to evaluate articles published on line (PubMed) from January 2011 until October 2012 in order to obtain an overview of recent progress of molecular imaging in malignant mesothelioma. The main topics concern the use of ¹⁸F-FDG-PET/CT in radiation therapy planning, monitoring of treatment (surgery/chemotherapy) response and prognosis assessment.
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Affiliation(s)
- Chiara Fuccio
- Nuclear Medicine Unit, Fondazione Salvatore Maugeri, Pavia, Italy.
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24
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Muralidharan V, Kwok M, Lee ST, Lau L, Scott AM, Christophi C. Prognostic ability of 18F-FDG PET/CT in the assessment of colorectal liver metastases. J Nucl Med 2012; 53:1345-51. [PMID: 22797376 DOI: 10.2967/jnumed.112.102749] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
UNLABELLED Modern multidisciplinary therapy for colorectal liver metastases (CRLM) is associated with significant morbidity and must be adapted to the patient's relative risk. The tools currently available to risk-stratify patients are limited. This study assessed the prognostic utility of metabolic measurements derived from(18)F-FDG PET compared with previously proposed prognostic scoring systems. METHODS Preoperative (18)F-FDG PET/CT studies from a series of 30 patients who underwent liver resection for CRLM after neoadjuvant chemotherapy were evaluated. Quantitative (18)F-FDG PET analysis calculated the maximum and mean standardized uptake value, metabolic tumor volume (MTV), and tumor glycolytic volume (TGV) as measures of the metabolic activity of tumors. The predictive value of these parameters was compared with that of 4 prognostic scores developed by Fong, Iwatsuki, Nordlinger, and Rees. RESULTS High MTV and TGV in patients before metastasectomy were significantly associated with poorer overall survival (MTV: P = 0.001; TGV: P = 0.004) and recurrence-free survival (MTV: P = 0.001, TGV; P = 0.002). Maximum and mean standardized uptake value did not show any significant predictive ability. Of the prognostic scores, prediction of outcome was most accurate using the Basingstoke index (area under the curve, 0.898). CONCLUSION Assessment of metabolic tumor burden with volumetric (18)F-FDG PET parameters appears to be a valuable adjunct in determining the biology of CRLM before surgical resection and may enable better risk stratification of patients.
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