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Tsao AS, Pass HI, Rimner A, Mansfield AS. New Era for Malignant Pleural Mesothelioma: Updates on Therapeutic Options. J Clin Oncol 2022; 40:681-692. [PMID: 34985934 PMCID: PMC8853621 DOI: 10.1200/jco.21.01567] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/06/2021] [Accepted: 09/23/2021] [Indexed: 12/13/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is a rare malignancy with few treatment options. Recent advances have led to US Food and Drug Administration approvals and changes in the standard of care with a novel biomedical device approved for use with platinum-pemetrexed, and also for immunotherapy agents to be included as a frontline treatment option in unresectable disease. Although predictive biomarkers for systemic therapy are not currently in use in clinical practice, it is essential to correctly identify the MPM histology to determine an optimal treatment plan. Patients with nonepithelioid MPM may have a greater magnitude of benefit to dual immunotherapy checkpoint inhibitors and this regimen should be preferred in the frontline setting for these patients. However, all patients with MPM can derive benefit from immunotherapy treatments, and these agents should ultimately be used at some point during their treatment journey. There are ongoing studies in the frontline unresectable setting that may further define the frontline therapy space, but a critical area of research will need to focus on the immunotherapy refractory population. This review article will describe the new developments in the areas of biology with genomics and chromothripsis, and also focus on updates in treatment strategies in radiology, surgery, radiation, and medical oncology with cellular therapies. These recent innovations are generating momentum to find better therapies for this disease.
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Affiliation(s)
- Anne S. Tsao
- The University of Texas MD Anderson Cancer Center, Department of Thoracic & Head and Neck Medical Oncology, Houston, TX
| | - Harvey I. Pass
- NYU Langone Medical Center, Department of Cardiothoracic Surgery, New York, NY
| | - Andreas Rimner
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, NY
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Lee CC, Soon YY, Vellayappan B, Leong CN, Koh WY, Tey JCS. Prophylactic irradiation of tracts in patients with malignant pleural mesothelioma: A systematic review and meta-analysis of randomized trials. Crit Rev Oncol Hematol 2021; 160:103278. [PMID: 33675903 DOI: 10.1016/j.critrevonc.2021.103278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/26/2021] [Accepted: 02/27/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION The role of prophylactic irradiation of tracts (PIT) to prevent tumor seeding at the site of a diagnostic or therapeutic intervention in patients with malignant pleural mesothelioma (MPM) is controversial. This study aimed to determine the efficacy of PITs in preventing procedure tract metastases (PTM) after a chest wall procedure in MPM. MATERIALS AND METHODS We searched various databases from inception date to April 2020 for randomized controlled trials (RCTs) comparing PIT with no PIT in patients who had a chest wall procedure for MPM. We assessed the risk of bias of individual RCT using the RoB2 tool. The primary outcome was the occurrence of PTM. Meta-analysis was performed using random-effects model. We employed the GRADE approach to assess the certainty of the evidence. RESULTS We identified five RCTs including 737 patients. Two RCTs had a low risk of bias. PIT was associated with a significant reduction in the odds of PTM (odd ratio, 0.55; 95 % confidence interval, 0.32 to 0.95; P-value = 0.03; I2 = 13 %; GRADE: moderate certainty). One RCT reported no difference in overall survival outcome with the use of PIT. None of the RCTs performed subgroup analyses. Sensitivity analyses showed similar results when limited to RCTs with low risk of bias. CONCLUSION PIT significantly reduces the occurrence of PTM in patients with MPM who had a diagnostic or therapeutic chest wall procedure.
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Affiliation(s)
- Chia Ching Lee
- Department of Radiation Oncology, National University Cancer Institute, Singapore; National University Hospital, Singapore; National University Health System, Singapore; National University of Singapore, Singapore.
| | - Yu Yang Soon
- Department of Radiation Oncology, National University Cancer Institute, Singapore; National University Hospital, Singapore; National University Health System, Singapore; National University of Singapore, Singapore.
| | - Balamurugan Vellayappan
- Department of Radiation Oncology, National University Cancer Institute, Singapore; National University Hospital, Singapore; National University Health System, Singapore; National University of Singapore, Singapore.
| | - Cheng Nang Leong
- Department of Radiation Oncology, National University Cancer Institute, Singapore; National University Hospital, Singapore; National University Health System, Singapore; National University of Singapore, Singapore.
| | - Wee Yao Koh
- Department of Radiation Oncology, National University Cancer Institute, Singapore; National University Hospital, Singapore; National University Health System, Singapore; National University of Singapore, Singapore.
| | - Jeremy C S Tey
- Department of Radiation Oncology, National University Cancer Institute, Singapore; National University Hospital, Singapore; National University Health System, Singapore; National University of Singapore, Singapore.
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Bayman N, Appel W, Ashcroft L, Baldwin DR, Bates A, Darlison L, Edwards JG, Ezhil V, Gilligan D, Hatton M, Jegannathen A, Mansy T, Peake MD, Pemberton L, Rintoul RC, Snee M, Ryder WD, Taylor P, Faivre-Finn C. Prophylactic Irradiation of Tracts in Patients With Malignant Pleural Mesothelioma: An Open-Label, Multicenter, Phase III Randomized Trial. J Clin Oncol 2019; 37:1200-1208. [PMID: 30920878 DOI: 10.1200/jco.18.01678] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Prophylactic irradiation to the chest wall after diagnostic or therapeutic procedures in patients with malignant pleural mesothelioma (MPM) has been a widespread practice across Europe, although the efficacy of this treatment is uncertain. In this study, we aimed to determine the efficacy of prophylactic radiotherapy in reducing the incidence of chest wall metastases (CWM) after a procedure in MPM. METHODS After undergoing a chest wall procedure, patients with MPM were randomly assigned to receive prophylactic radiotherapy (within 42 days of the procedure) or no radiotherapy. Open thoracotomies, needle biopsies, and indwelling pleural catheters were excluded. Prophylactic radiotherapy was delivered at a dose of 21 Gy in three fractions over three consecutive working days, using a single electron field adapted to maximize coverage of the tract from skin surface to pleura. The primary outcome was the incidence of CWM within 6 months from random assignment, assessed in the intention-to-treat population. Stratification factors included epithelioid histology and intention to give chemotherapy. RESULTS Between July 30, 2012, and December 12, 2015, 375 patients were recruited from 54 centers and randomly assigned to receive prophylactic radiotherapy (n = 186) or no prophylactic radiotherapy (n = 189). Participants were well matched at baseline. No significant difference was seen in the incidence of CWM at 6 months between the prophylactic radiotherapy and no radiotherapy groups (no. [%]: 6 [3.2] v 10 [5.3], respectively; odds ratio, 0.60; 95% CI, 0.17 to 1.86; P = .44). Skin toxicity was the most common radiotherapy-related adverse event in the prophylactic radiotherapy group, with 96 patients (51.6%) receiving grade 1; 19 (10.2%), grade 2; and 1 (0.5%) grade 3 radiation dermatitis (Common Terminology Criteria for Adverse Events, version 4.0). CONCLUSION There is no role for the routine use of prophylactic irradiation to chest wall procedure sites in patients with MPM.
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Affiliation(s)
- Neil Bayman
- 1 The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Wiebke Appel
- 2 Lancashire Teaching Hospitals National Health Service Foundation Trust, Preston, United Kingdom
| | - Linda Ashcroft
- 1 The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - David R Baldwin
- 3 Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
| | - Andrew Bates
- 4 University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Liz Darlison
- 5 University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom
| | - John G Edwards
- 6 Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Veni Ezhil
- 7 Royal Surrey County Hospital, National Health Service Foundation Trust, Guildford, United Kingdom
| | - David Gilligan
- 8 Cambridge University Hospital National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Matthew Hatton
- 6 Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Apurna Jegannathen
- 9 University Hospitals of North Midlands National Health Service Trust, Stoke-on-Trent, United Kingdom
| | - Talal Mansy
- 10 South Tees Hospitals National Health Service Foundation Trust, Middlesbrough, United Kingdom
| | - Michael D Peake
- 5 University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom
| | - Laura Pemberton
- 1 The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Robert C Rintoul
- 11 Cancer Research UK Cambridge Centre, Cambridge, United Kingdom
| | - Michael Snee
- 12 Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
| | - W David Ryder
- 1 The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Paul Taylor
- 13 Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- 1 The Christie National Health Service Foundation Trust, Manchester, United Kingdom.,14 University of Manchester, Manchester, United Kingdom
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Prophylactic radiotherapy for procedure tract metastases in mesothelioma: a review. Curr Opin Pulm Med 2018; 23:357-364. [PMID: 28426469 DOI: 10.1097/mcp.0000000000000385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Malignant pleural mesothelioma is an aggressive malignancy with a very poor prognosis. The majority of patients require pleural procedures for diagnostic or fluid management purposes. Damage to the pleura during these procedures can lead to procedure tract metastases (PTMs), with increasing risk from larger interventions. Prophylactic radiotherapy to these sites is a controversial topic with conflicting results from trial data. In this review, we summarize the recent evidence. RECENT FINDINGS Four RCTs have been published on this topic, with another in follow-up. The earliest, from a cohort of 40 patients, strongly advocated the use of prophylactic radiotherapy. More recent trials, most notably the Surgical and large bore procedures in Malignant pleural mesothelioma And Radiotherapy Trial (SMART) (which randomized over 200 patients) did not demonstrate any benefit, especially when patient report symptoms and cost-effectiveness are considered. Certain subgroups demand further investigation, such as those not receiving systematic chemotherapy or with surgical intervention sites. The soon to be published Prophylactic Irradiation of Tracts (PIT) trial may help to further clarify best practice. SUMMARY Recent studies have shown that prophylactic radiotherapy should not be routinely used to prevent PTMs in mesothelioma. Instead patients should undergo careful clinical follow-up to ensure PTMs are identified and treated promptly to minimize symptoms.
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Kindler HL, Ismaila N, Armato SG, Bueno R, Hesdorffer M, Jahan T, Jones CM, Miettinen M, Pass H, Rimner A, Rusch V, Sterman D, Thomas A, Hassan R. Treatment of Malignant Pleural Mesothelioma: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2018; 36:1343-1373. [PMID: 29346042 DOI: 10.1200/jco.2017.76.6394] [Citation(s) in RCA: 262] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose To provide evidence-based recommendations to practicing physicians and others on the management of malignant pleural mesothelioma. Methods ASCO convened an Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary, pathology, imaging, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 1990 through 2017. Outcomes of interest included survival, disease-free or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. Results The literature search identified 222 relevant studies to inform the evidence base for this guideline. Recommendations Evidence-based recommendations were developed for diagnosis, staging, chemotherapy, surgical cytoreduction, radiation therapy, and multimodality therapy in patients with malignant pleural mesothelioma. Additional information is available at www.asco.org/thoracic-cancer-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Hedy L Kindler
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nofisat Ismaila
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samuel G Armato
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Raphael Bueno
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mary Hesdorffer
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Thierry Jahan
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Clyde Michael Jones
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Markku Miettinen
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Harvey Pass
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andreas Rimner
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Valerie Rusch
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel Sterman
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anish Thomas
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Raffit Hassan
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
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Carette H, Faivre JC, Salleron J, Baumann AS, Uwer L, Clément-Duchêne C, Vignaud JM, Petit I, Siat J, Tiotiu A, Beckendorf V. [Prophylactic radiotherapy in a single fraction of 10Gy at intervention pleural site in patient with malignant pleural mesothelioma: A retrospective monocentric cohort study]. Cancer Radiother 2017; 21:774-783. [PMID: 29132802 DOI: 10.1016/j.canrad.2017.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/20/2017] [Accepted: 06/09/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE Prophylactic radiotherapy to prevent procedure-tracts metastases from malignant pleural mesothelioma remains controversial and clinical practice varies. The purpose was to assess the efficacy of local radiotherapy in a single fraction of 10Gy in preventing malignant seeding at intervention pleural site in patients with malignant pleural mesothelioma. MATERIAL AND METHODS This is a retrospective cohort study, including patients with histological confirmed malignant pleural mesothelioma treated by prophylactic irradiation to prevent interventional site metastases with a unique fraction of 10Gy with 6 to 18MeV, from January 1990 to December 2013 in the institut de cancérologie de Lorraine (Nancy, France). RESULTS Ninety-one patients were treated by irradiation in intervention site, involving 120 intervention pleural sites, 91 thoracoscopies, 17 thoracotomies with chest drain and 12 CT or ultrasound guided needle biopsies. The median follow-up was 7 months (interquartile between 3 and 15 months). The overall survival was 43.5% at 12 months. The local progression free survival was 43.7% at 12 month. The incidence of local recurrence was 8% at 12 months. The median interval from radiotherapy to local recurrence was 4 months (2; 32). No grade II or higher toxicity was observed. CONCLUSION Irradiation of pleural intervention sites with a single fraction of 10Gy is effective, well tolerated, simple, fast and cost effective.
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Affiliation(s)
- H Carette
- Département de pneumologie, CHRU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - J-C Faivre
- Département de radiothérapie, institut de cancérologie de Lorraine Alexis-Vautrin, 6, avenue de Bourgogne CS 30519, 54519 Vandœuvre-lès-Nancy, France.
| | - J Salleron
- Département de biostatistiques, institut de cancérologie de Lorraine Alexis-Vautrin, 6, avenue de Bourgogne CS 30519, 54519 Vandœuvre-lès-Nancy, France
| | - A-S Baumann
- Département de radiothérapie, institut de cancérologie de Lorraine Alexis-Vautrin, 6, avenue de Bourgogne CS 30519, 54519 Vandœuvre-lès-Nancy, France
| | - L Uwer
- Département d'oncologie médicale, institut de cancérologie de Lorraine Alexis-Vautrin, 6, avenue de Bourgogne CS 30519, 54519 Vandœuvre-lès-Nancy, France
| | - C Clément-Duchêne
- Département d'oncologie médicale, institut de cancérologie de Lorraine Alexis-Vautrin, 6, avenue de Bourgogne CS 30519, 54519 Vandœuvre-lès-Nancy, France
| | - J-M Vignaud
- Laboratoire d'anatomie et cytologie pathologiques, CHRU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - I Petit
- Département de radiologie, CHRU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - J Siat
- Département de chirurgie thoracique, CHRU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - A Tiotiu
- Département de pneumologie, CHRU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - V Beckendorf
- Département de radiothérapie, institut de cancérologie de Lorraine Alexis-Vautrin, 6, avenue de Bourgogne CS 30519, 54519 Vandœuvre-lès-Nancy, France
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A Single-Institution Experience in Percutaneous Image-Guided Biopsy of Malignant Pleural Mesothelioma. Cardiovasc Intervent Radiol 2017; 40:860-863. [PMID: 28138725 DOI: 10.1007/s00270-017-1583-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Mesothelioma has been considered a difficult pathologic diagnosis to achieve via image-guided core needle biopsy. The purpose of this study was to assess the diagnostic sensitivity of percutaneous image-guided biopsy for diagnosis of pleural mesothelioma. MATERIALS AND METHODS Retrospective review was performed to identify patients with a confirmed diagnosis of pleural mesothelioma and who underwent image-guided needle biopsy between January 1, 2002, and January 1, 2016. Thirty-two patients with pleural mesothelioma were identified and included for analysis in 33 image-guided biopsy procedures. Patient, procedural, and pathologic characteristics were recorded. Complications were characterized via standardized nomenclature [Common Terminology for Clinically Adverse Events (CTCAE)]. RESULTS Percutaneous image-guided biopsy was associated with an overall sensitivity of 81%. No CTCAE clinically significant complications were observed. No image-guided procedures were complicated by pneumothorax or necessitated chest tube placement. No patients had tumor seeding of the biopsy tract. CONCLUSION Percutaneous image-guided biopsy can achieve high sensitivity for pathologic diagnosis of pleural mesothelioma with a low procedural complication rate, potentially obviating need for surgical biopsy.
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Abdel-Rahman O. Role of postoperative radiotherapy in the management of malignant pleural mesothelioma : A propensity score matching of the SEER database. Strahlenther Onkol 2017; 193:276-284. [PMID: 28044200 DOI: 10.1007/s00066-016-1092-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/29/2016] [Indexed: 12/29/2022]
Abstract
INTRODUCTION This study assessed the prognostic impact of postoperative radiotherapy in patients with surgically resected malignant pleural mesothelioma (MPM). METHODS MPM patients diagnosed between 2000 and 2013 were identified from the SEER (Surveillance, Epidemiology, and End Results) database. A propensity-matched analysis was performed considering baseline characteristics (age, gender, race, histology, TNM stage, and type of surgery). RESULTS A total of 2166 patients were identified. The median age was 60 years (range 25-85 years), and 469 patients received postoperative radiotherapy. Both before and after propensity score matching, overall survival (P < 0.0001 and P = 0.012, respectively) was better in the postoperative radiotherapy group. When the overall survival was stratified by histology, postoperative radiotherapy did not improve the survival in sarcomatoid histology patients both before and after matching (P = 0.424 and P = 0.281, respectively). In multivariate analysis of the matched population, not receiving postoperative radiotherapy did not correlate with worse survival (hazard ratio: 1.175; P = 0.12). Factors associated with worse survival include sarcomatoid histology, nodal positivity, and age ≥70. CONCLUSION Evidence from this analysis is insufficient on its own to routinely recommend postoperative radiotherapy for surgically resected MPM. However, large-scale prospective clinical trials are warranted to further evaluate this intervention in nonsarcomatoid histology.
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Affiliation(s)
- Omar Abdel-Rahman
- Clinical Oncology department, Faculty of medicine, Ain Shams University, Cairo, Egypt.
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Clive AO, Taylor H, Dobson L, Wilson P, de Winton E, Panakis N, Pepperell J, Howell T, Stewart SA, Penz E, Jordan N, Morley AJ, Zahan-Evans N, Smith S, Batchelor TJP, Marchbank A, Bishop L, Ionescu AA, Bayne M, Cooper S, Kerry A, Jenkins P, Toy E, Vigneswaran V, Gildersleve J, Ahmed M, McDonald F, Button M, Lewanski C, Comins C, Dakshinamoorthy M, Lee YCG, Rahman NM, Maskell NA. Prophylactic radiotherapy for the prevention of procedure-tract metastases after surgical and large-bore pleural procedures in malignant pleural mesothelioma (SMART): a multicentre, open-label, phase 3, randomised controlled trial. Lancet Oncol 2016; 17:1094-1104. [PMID: 27345639 PMCID: PMC4961873 DOI: 10.1016/s1470-2045(16)30095-x] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/14/2016] [Accepted: 04/15/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The use of prophylactic radiotherapy to prevent procedure-tract metastases (PTMs) in malignant pleural mesothelioma remains controversial, and clinical practice varies worldwide. We aimed to compare prophylactic radiotherapy with deferred radiotherapy (given only when a PTM developed) in a suitably powered trial. METHODS We did a multicentre, open-label, phase 3, randomised controlled trial in 22 UK hospitals of patients with histocytologically proven mesothelioma who had undergone large-bore pleural interventions in the 35 days prior to recruitment. Eligible patients were randomised (1:1), using a computer-generated sequence, to receive immediate radiotherapy (21 Gy in three fractions within 42 days of the pleural intervention) or deferred radiotherapy (same dose given within 35 days of PTM diagnosis). Randomisation was minimised by histological subtype, surgical versus non-surgical procedure, and pleural procedure (indwelling pleural catheter vs other). The primary outcome was the incidence of PTM within 7 cm of the site of pleural intervention within 12 months from randomisation, assessed in the intention-to-treat population. This trial is registered with ISRCTN, number ISRCTN72767336. FINDINGS Between Dec 23, 2011, and Aug 4, 2014, we randomised 203 patients to receive immediate radiotherapy (n=102) or deferred radiotherapy (n=101). The patients were well matched at baseline. No significant difference was seen in PTM incidence in the immediate and deferred radiotherapy groups (nine [9%] vs 16 [16%]; odds ratio 0·51 [95% CI 0·19-1·32]; p=0·14). The only serious adverse event related to a PTM or radiotherapy was development of a painful PTM within the radiotherapy field that required hospital admission for symptom control in one patient who received immediate radiotherapy. Common adverse events of immediate radiotherapy were skin toxicity (grade 1 in 50 [54%] and grade 2 in four [4%] of 92 patients vs grade 1 in three [60%] and grade 2 in two [40%] of five patients in the deferred radiotherapy group who received radiotherapy for a PTM) and tiredness or lethargy (36 [39%] in the immediate radiotherapy group vs two [40%] in the deferred radiotherapy group) within 3 months of receiving radiotherapy. INTERPRETATION Routine use of prophylactic radiotherapy in all patients with mesothelioma after large-bore thoracic interventions is not justified. FUNDING Research for Patient Benefit Programme from the UK National Institute for Health Research.
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Affiliation(s)
- Amelia O Clive
- Respiratory Research Unit, North Bristol National Health Service (NHS) Trust, Southmead Hospital, Bristol, UK; Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Lee Dobson
- South Devon Healthcare NHS Foundation Trust, Torbay, UK
| | - Paula Wilson
- University Hospitals Bristol NHS Trust, Bristol, UK
| | | | - Niki Panakis
- Oxford University Hospitals NHS Trust, Oxford, UK
| | | | | | | | - Erika Penz
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Nikki Jordan
- Respiratory Research Unit, North Bristol National Health Service (NHS) Trust, Southmead Hospital, Bristol, UK
| | - Anna J Morley
- Respiratory Research Unit, North Bristol National Health Service (NHS) Trust, Southmead Hospital, Bristol, UK
| | - Natalie Zahan-Evans
- Respiratory Research Unit, North Bristol National Health Service (NHS) Trust, Southmead Hospital, Bristol, UK
| | - Sarah Smith
- Respiratory Research Unit, North Bristol National Health Service (NHS) Trust, Southmead Hospital, Bristol, UK
| | | | | | | | - Alina A Ionescu
- Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK
| | - Mike Bayne
- Poole Hospital NHS Foundation Trust, Poole, UK; Dorset County Hospital NHS Foundation Trust, Dorchester, UK
| | - Samantha Cooper
- Colchester Hospital University NHS Foundation Trust, Colchester, UK
| | | | - Peter Jenkins
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Elizabeth Toy
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | | | - Merina Ahmed
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | | | | | | | - Y C Gary Lee
- Centre for Respiratory Health, School of Medicine & Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Najib M Rahman
- Oxford University Hospitals NHS Trust, Oxford, UK; Oxford National Institute for Health Research (NIHR) Biomedical Research Centre, Oxford, UK
| | - Nick A Maskell
- Respiratory Research Unit, North Bristol National Health Service (NHS) Trust, Southmead Hospital, Bristol, UK; Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
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10
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Patel SC, Dowell JE. Modern management of malignant pleural mesothelioma. LUNG CANCER-TARGETS AND THERAPY 2016; 7:63-72. [PMID: 28210162 PMCID: PMC5310692 DOI: 10.2147/lctt.s83338] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Malignant pleural mesothelioma (MPM) is a deadly disease that produces a significant worldwide health care burden. The majority of cases are associated with prior asbestos exposure, but recent studies have identified a possible genetic predisposition in a minority of patients. Historically, obtaining a pathologic diagnosis of MPM was challenging, but with current pathological techniques, a secure diagnosis is possible in the majority of patients. Curative therapy for MPM remains elusive, and the primary treatment option for fit patients is platinum-based chemotherapy. Encouraging recent reports suggest that there may be a benefit to the addition of bevacizumab to standard chemotherapy as well as with the use of immune checkpoint inhibitors in MPM. Selected patients may be considered for aggressive surgical approaches, but there is considerable controversy regarding the true benefit of surgery and multimodality therapy in this disease.
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Affiliation(s)
- Shivani C Patel
- Division of Hematology and Oncology, University of Texas Southwestern
| | - Jonathan E Dowell
- Division of Hematology and Oncology, University of Texas Southwestern; Section of Hematology and Oncology, Veterans Affairs North Texas Healthcare System, Dallas, TX, USA
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11
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Roca E, Astoul P. Malignant pleural mesothelioma signs and symptoms. Lung Cancer Manag 2015. [DOI: 10.2217/lmt.15.24] [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 (MPM) is developed from mesothelial cells and its behavior depends on the degree of pleural invasion and adjacent organs. This extension around the pleural cavity or more unlikely located on a limited area leads to clinical signs as dyspnea, shortness of breath, cough or chest pain. The relationship between asbestos exposure and MPM has been well established. The symptoms of MPM usually appear 30–40 years after exposure to asbestos. Consequently, patients are unaware that the clinical presentation is related to their clinical exposure which happened much earlier in their lives. Clinical manifestations of MPM are usually nonspecific and should not be used alone as diagnostic criteria, even in case of previous asbestos exposure as recommended by the ERS guidelines.
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Affiliation(s)
- Elisa Roca
- Department of Thoracic Oncology, Pleural Diseases, & Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases, & Interventional Pulmonology, Hôpital Nord, Marseille, France
- Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France
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12
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Bertolaccini L, Viti A, Terzi A. To seed or not to seed: the open question of mesothelioma intervention tract metastases. Chest 2015; 146:e111. [PMID: 25180738 DOI: 10.1378/chest.14-0822] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Luca Bertolaccini
- Thoracic Surgery Unit, S Croce e Carle Teaching Hospital, Cuneo, Italy.
| | - Andrea Viti
- Thoracic Surgery Unit, S Croce e Carle Teaching Hospital, Cuneo, Italy
| | - Alberto Terzi
- Thoracic Surgery Unit, Sacred Heart Research Hospital, Negrar, Verona, Italy
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13
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Opitz I. Management of malignant pleural mesothelioma-The European experience. J Thorac Dis 2014; 6 Suppl 2:S238-52. [PMID: 24868442 DOI: 10.3978/j.issn.2072-1439.2014.05.03] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 05/08/2014] [Indexed: 12/29/2022]
Abstract
Management of malignant pleural mesothelioma (MPM) remains a clinical challenge and the incidence of the disease will continue to increase worldwide. Several aspects of mesothelioma treatment are discussed controversially, in particular, regarding extent and best type of surgery, radiotherapy, and the role of neoadjuvant or adjuvant treatment. However, best survival data is reported from groups using multimodality treatment including macroscopic complete resection (MCR) achieved by either extrapleural pneumonectomy (EPP) or (extended) pleurectomy/decortication for patients qualifying from the tumor biology, stage, and patient's performance status and comorbidities. Several aspects have to be considered during surgery but morbidity and mortality have been reduced at experienced centres. The final analysis of extended selection algorithms is pending.
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Affiliation(s)
- Isabelle Opitz
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
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14
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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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