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Laune Q, Brosseau S. [New MAA: First-line nivolumab plus ipilimumab in unresectable malignant pleural mesothelioma]. Bull Cancer 2021:S0007-4551(21)00437-9. [PMID: 34848048 DOI: 10.1016/j.bulcan.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/12/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Quentin Laune
- Centre Hospitalier Universitaire de Brest, Service Oncologie, Hôpital Morvan, 2, avenue Maréchal Foch Brest, 29200 Finistère, Bretagne
| | - Solenn Brosseau
- Université de Paris, Service d'Oncologie Thoracique-CIC INSERM 1425, Institut Universitaire du Cancer Paris-Nord, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), 46, rue Henri Huchard, 75018 Paris; U830 INSERM Cancer Hétérogénéité et Plasticité, Centre de recherche, Institut Curie, 75231 Paris cedex 05.
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Laune Q, Brosseau S. [New MAA: First-line nivolumab plus ipilimumab in unresectable malignant pleural mesothelioma]. Bull Cancer 2021; 109:4-6. [PMID: 34654542 DOI: 10.1016/j.bulcan.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Quentin Laune
- Centre hospitalier universitaire de Brest, hôpital Morvan, service oncologie, 2, avenue Maréchal-Foch-Brest, 29200 Finistère, France.
| | - Solenn Brosseau
- Assistance publique-Hôpitaux de Paris (AP-HP), université de Paris, institut universitaire du Cancer Paris-Nord, hôpital Bichat-Claude Bernard, service d'oncologie thoracique-CIC, Inserm 1425, 46, rue Henri-Huchard, 75018 Paris, France; Institut Curie, centre de recherche, U830 Inserm cancer hétérogénéité et plasticité, 75231 Paris cedex 05, France
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Mlika M, Lamzirbi O, Limam M, Mejri N, Ben Saad S, Chaouch N, Ben Miled K, Marghli A, Mezni F. [Clinical and pathological profile of the pleural malignant mesothelioma: A retrospective study about 30 cases]. Rev Pneumol Clin 2018; 74:427-435. [PMID: 30293912 DOI: 10.1016/j.pneumo.2018.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/24/2018] [Accepted: 06/14/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The malignant pleural mesothelioma (MPM) is a rare tumour usually associated to asbestos exposure. The delay between the exposure and the occurrence of the cancer can reach 40 years. This caused the pick of incidence described in many countries including Tunisia. The diagnosis is suspected based on clinical features but positive diagnosis is microscopic. Our aim was to describe the clinical and microscopic features of MPM through a single institution experience. PATIENTS AND METHODS We conducted a retrospective study about 30 MPM diagnosed over a 20-year-period (1995-2015). We included only patients with complete records including clinical, radiologic and microscopic features. All the microscopic diagnoses were reviewed by 2 pathologists. A mean of 12 slides per case was reviewed. The diagnosis was based on the 2015 WHO classification. RESULTS The mean age of the patients was 61 years, average 22 to 80 years. The sex ratio was 6,5. An asbetose exposition was reported in 21 cases. The most frequent symptoms was chest pain reported in 25 cases. Physical exam was normal in 9 cases. It revealed pleural syndorm in most patients (60 %). Imaging findings consisted mainly in diffuse pleural thickening in 17 cases. Twelve tumours were classified as stage I, 3 stage II, 14 stage III et 1 stage IV. Pleural biopsy was performed using needle in 18 cases, through thoracoscopy in 16 cases, thoracotomy in 3 cases and allowed the diagnosis in respectively 7 cases/18, 16 cases/16 and 3 cases/3. A lymph node biopsy was performed through mediastinoscopy in one case and yelded the diagnosis. The diagnosis was performed on surgical specimen in 2 patients: one bullectomy and one right upper lobectomy. The microscopic exam concluded to an EM in 17 cases, sarcomatoid mesothelioma (SM) in 4 cases and biphasic mesothelioma (BM) in 9 cases. Pan-cytokeratin antibody was used in all cases in association with 2 antibodies with positive diagnostic value and 2 antibodies with negative diagnostic value. It was repeated in 15 cases and the most used antibodies were the anti-calretinin and the TTF1. This was due to the lack of fixation in one case and in order to reach a quality criteria in the other cases. Surgical resection was possible in 2 patients. 15 patients were lost of view after a mean follow-up period of 3 months. Thirteen patients died before or during the follow-up. CONCLUSION This work was about a Tunisian experience in the diagnosis and management of MPM. The major limits faced were the incomplete databases, the small number of patients included. Microsocpic positive diagnosis necessitates a degree of expertise and every laboratory has to determine the most valuable antibodies through its experience in order to optimize the diagnosis and to reduce the delay of diagnosis.
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Affiliation(s)
- M Mlika
- Service de Pathologie, Hôpital Abderrahman Mami, 2037 Ariana, Tunisie; Unité de recherche, 12SP18, Ariana, Tunisie.
| | - O Lamzirbi
- Service de Pathologie, Hôpital Abderrahman Mami, 2037 Ariana, Tunisie; Unité de recherche, 12SP18, Ariana, Tunisie
| | - M Limam
- Unité de recherche, 12SP18, Ariana, Tunisie
| | - N Mejri
- Unité de recherche, 12SP18, Ariana, Tunisie
| | - S Ben Saad
- Unité de recherche, 12SP18, Ariana, Tunisie; Service de Pneumologie, Pavillon IV, Hôpital Abderrahman Mami, Ariana, Tunisie
| | - N Chaouch
- Service de Pneumologie, Pavillon II, Hôpital Abderrahman Mami, Ariana, Tunisie
| | - K Ben Miled
- Service de Radiologie, Hôpital Abderrahman Mami, Ariana, Tunisie
| | - A Marghli
- Service de Chrirugie Thoracique, Hôpital Abderrahman Mami, Ariana, Tunisie
| | - F Mezni
- Service de Pathologie, Hôpital Abderrahman Mami, 2037 Ariana, Tunisie; Unité de recherche, 12SP18, Ariana, Tunisie
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Fournel L, Janet-Vendroux A, Canny-Hamelin E, Mansuet-Lupo A, Guinet C, Bobbio A, Damotte D, Alifano M. [Malignant pleural mesothelioma: The role of surgery]. Rev Pneumol Clin 2018; 74:351-358. [PMID: 30316650 DOI: 10.1016/j.pneumo.2018.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Malignant pleural mesothelioma (MPM) is a rare and highly aggressive disease, whose incidence is increasing. Asbestos is the primary causal agent. STATE OF KNOWLEDGE Knowledge about MPM has evolved. Thoracoscopy is essential for diagnosis of MPM. It allows performing pleural biopsies, to study the extent of the disease and to relieve dyspnea. The pathological diagnosis is also better codified with immunohistochemistry and with analysis by expert of Mesopath group. Curative surgical treatments are pleurectomy decortication and extended pneumonectomy in combination with chemotherapy and/or radiotherapy. Those heavy treatments improve survival in highly selected patients. For the other patients, supportive measures will be considered to reduce pain and dyspnea. PROSPECT Radical surgical treatment is only offered in therapeutic trials or multimodal treatment. Its place is not formally established. New therapies associated to surgical treatment are being studied. CONCLUSIONS Surgical management of MPM has to be operated in specialized teams where the survival benefit and quality of life is discussed case by case.
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Affiliation(s)
- L Fournel
- Service de chirurgie thoracique, université Paris Descartes, hôpital Cochin, hôpitaux universitaires Paris-Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - A Janet-Vendroux
- Service de chirurgie thoracique, université Paris Descartes, hôpital Cochin, hôpitaux universitaires Paris-Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - E Canny-Hamelin
- Service de chirurgie thoracique, université Paris Descartes, hôpital Cochin, hôpitaux universitaires Paris-Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - A Mansuet-Lupo
- Service d'anatomopathologie, université Paris Descartes, hôpitaux universitaires Paris-Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - C Guinet
- Service de radiologie, université Paris Descartes, hôpitaux universitaires Paris-Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - A Bobbio
- Service de chirurgie thoracique, université Paris Descartes, hôpital Cochin, hôpitaux universitaires Paris-Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - D Damotte
- Service d'anatomopathologie, université Paris Descartes, hôpitaux universitaires Paris-Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - M Alifano
- Service de chirurgie thoracique, université Paris Descartes, hôpital Cochin, hôpitaux universitaires Paris-Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
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Scherpereel A, Willemin MC, Wasielewski E, Dhalluin X. [Anti-tumor immunotherapy in malignant pleural mesothelioma]. Rev Mal Respir 2018; 35:465-476. [PMID: 29415822 DOI: 10.1016/j.rmr.2017.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/07/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Malignant pleural mesothelioma (MPM) is a quite rare cancer, but with increasing incidence, that is usually induced by previous asbestos exposure. Its prognosis is poor and there is no validated curative therapy to date. Surgery of MPM, done only by few expert teams within a multimodal treatment is of limited and still disputed value. The standard treatment of MPM, relying on first-line chemotherapy by combined cisplatin-pemetrexed is often poorly effective, even if combination with bevacizumab anti-VEGF antibodies has slightly improved the results. Moreover, no second line treatment is recommended in case of failure of this chemotherapy. Therefore, the search of new therapies or strategies is crucial and the recruitment of patients in clinical trials is highly encouraged. BACKGROUND Among the treatments under investigation, various anti-tumour immunotherapies, in particular immune checkpoints inhibitors (ICI), currently exhibit the most promising preliminary results. First data from the phase II, randomized "IFCT MAPS-2", recently presented during the 2017 ASCO meeting, confirmed the value of ICI in MPM patients in cases of chemotherapy failure. OUTLOOK AND CONCLUSIONS However, several exciting immunotherapies other than ICI are presently being evaluated in MPM and are reported in this article. Moreover, many questions still need to be answered about immunotherapy: what is its potential value as first line treatment? How to target the best candidates for these treatments? Which combinations between immunotherapy and standard chemotherapy, targeted therapies, surgery or radiotherapy? Finally, it is now essential that every clinician has sufficient knowledge about the possible toxicities of immunotherapy.
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Affiliation(s)
- A Scherpereel
- Pneumologie et oncologie thoracique, université Lille, Inserm U1019, CHU de Lille, CIIL, Institut Pasteur, 59000 Lille, France; MESOCLIN-réseau national des centres cliniques experts pour la prise en charge des mésothéliomes pleuraux malins, domiciliation du centre coordinateur national, CHU de Lille, 59000 Lille, France.
| | - M-C Willemin
- Pneumologie et oncologie thoracique, université Lille, Inserm U1019, CHU de Lille, CIIL, Institut Pasteur, 59000 Lille, France; MESOCLIN-réseau national des centres cliniques experts pour la prise en charge des mésothéliomes pleuraux malins, domiciliation du centre coordinateur national, CHU de Lille, 59000 Lille, France
| | - E Wasielewski
- Pneumologie et oncologie thoracique, université Lille, Inserm U1019, CHU de Lille, CIIL, Institut Pasteur, 59000 Lille, France; MESOCLIN-réseau national des centres cliniques experts pour la prise en charge des mésothéliomes pleuraux malins, domiciliation du centre coordinateur national, CHU de Lille, 59000 Lille, France
| | - X Dhalluin
- Pneumologie et oncologie thoracique, université Lille, Inserm U1019, CHU de Lille, CIIL, Institut Pasteur, 59000 Lille, France; MESOCLIN-réseau national des centres cliniques experts pour la prise en charge des mésothéliomes pleuraux malins, domiciliation du centre coordinateur national, CHU de Lille, 59000 Lille, France
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Parisi E, Romeo A, Sarnelli A, Ghigi G, Bellia SR, Neri E, Micheletti S, Dipalma B, Arpa D, Furini G, Burgio MA, Genestreti G, Gurioli C, Sanna S, Bovolato P, Rea F, Storme G, Scarpi E, Arienti C, Tesei A, Polico R. High dose irradiation after pleurectomy/decortication or biopsy for pleural mesothelioma treatment. Cancer Radiother 2017; 21:766-773. [PMID: 29132803 DOI: 10.1016/j.canrad.2017.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/18/2017] [Accepted: 05/19/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE The role played by radiation therapy after pleurectomy/decortication or surgical biopsy in malignant pleural mesothelioma is uncertain. We treated patients with accelerated hypofractionated radiotherapy using helical tomotherapy and intensity-modulated arc therapy in an attempt to keep lung toxicity to a minimum. The present study reports the feasibility and toxicity of this approach. MATERIAL AND METHODS Between 2008 and 2012, 36 patients with malignant pleural mesothelioma underwent accelerated hypofractionated radiotherapy to the hemithorax after pleurectomy/decortication (19 patients) or biopsy (17 patients). The prescription dose was 25Gy in five fractions over 5 consecutive days. RESULTS We observed three patients with G3 pneumonitis, five cases of grade 2 dyspnea and six cases of grade 2 cough. The median follow-up was 37 months (range: 3-54 months). The median overall survival for patients who underwent pleurectomy/decortication followed by radiotherapy was 21.6 months [95% confidence interval (95% CI): 15.5-24.1] compared to 19.4 months for patients not submitted to surgery. CONCLUSION Treatment of intact lung with pleural intensity-modulated arc irradiation in malignant pleural mesothelioma patients with malignant pleural mesothelioma proved safe and feasible, with an acceptable rate of pneumonitis. Survival rates were encouraging for both biopsy-only and pleurectomy/decortication groups. We are currently conducting a phase II dose escalation trial in a similar patient setting to prospectively evaluate the impact of radiotherapy on toxicity, disease-free survival and overall survival.
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Affiliation(s)
- E Parisi
- Radiotherapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via P. Maroncelli 40, 47014 Meldola, Italy.
| | - A Romeo
- Radiotherapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via P. Maroncelli 40, 47014 Meldola, Italy
| | - A Sarnelli
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - G Ghigi
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - S R Bellia
- Radiotherapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via P. Maroncelli 40, 47014 Meldola, Italy
| | - E Neri
- Radiotherapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via P. Maroncelli 40, 47014 Meldola, Italy
| | - S Micheletti
- Radiotherapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via P. Maroncelli 40, 47014 Meldola, Italy
| | - B Dipalma
- Radiotherapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via P. Maroncelli 40, 47014 Meldola, Italy
| | - D Arpa
- Radiotherapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via P. Maroncelli 40, 47014 Meldola, Italy
| | - G Furini
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - M A Burgio
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - G Genestreti
- Department of Medical Oncology, Bellaria Hospital, Bologna, Italy
| | - C Gurioli
- Department of Pneumology, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - S Sanna
- Department of Thoracic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - P Bovolato
- Department of Thoracic Surgery, Spedali Civili di Brescia, Brescia, Italy
| | - F Rea
- Department of Thoracic Surgery, Azienda Ospedaliera Padova, University of Padua, Padua, Italy
| | - G Storme
- Department of Radiation Oncology, Oncologic Centre UZ, Brussels, Belgium
| | - E Scarpi
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - C Arienti
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - A Tesei
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - R Polico
- Radiotherapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via P. Maroncelli 40, 47014 Meldola, Italy
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Helou J, Clément-Colmou K, Sylvestre A, Campion L, Amessis M, Zefkili S, Raphael J, Bonnette P, Le Pimpec Barthes F, Périgaud C, Mahé MA, Giraud P. [Helical tomotherapy in the treatment of malignant pleural mesothelioma: The impact of low doses on pulmonary and oesophageal toxicity]. Cancer Radiother 2013; 17:755-62. [PMID: 24269017 DOI: 10.1016/j.canrad.2013.06.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 05/17/2013] [Accepted: 06/24/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the adjuvant treatment of malignant pleural mesothelioma by helical tomotherapy and the impact of low doses on esophageal and pulmonary toxicity. PATIENTS AND METHODS Between June 2007 and May 2011, 29 patients diagnosed with malignant pleural mesothelioma received adjuvant radiotherapy by helical tomotherapy. The median age was 63 years (34-72). Histologically, 83 % of patients had epithelioid malignant pleural mesothelioma. Clinically, 45 % of patients were T3 and 55 % N0. Eighty six percent of the patients were treated by extrapleural pneumonectomy and 35 % received neoadjuvant chemotherapy with platinum and pemetrexed. The median dose in the pneumonectomy cavity was 50Gy at 2Gy/fraction. RESULTS The mean follow-up was 2.3 years after diagnosis. Overall survival at 1 and 2 years was 65 and 36 % respectively. The median survival from diagnosis was 18 months. Median lung volumes receiving 2, 5, 10, 13, 15 and 20Gy (V2, V5, V10, V13, V15 and V20) were 100, 98, 52, 36, 19 and 5 %. The median of the mean remaining lung dose was 11Gy. Two patients died of pulmonary complications, three patients had grade 3 lung toxicity, while esophageal grade 3-4 toxicity was observed in three other patients. No significant impact of clinical characteristics and dosimetric parameters were found on pulmonary toxicity, however a V10≥50 %, a V15≥15 % and mean lung dose of 10Gy or more had a tendency to be predictive of pulmonary toxicity (P<0.1). Moreover, in our analysis, the mean lung dose seems to have a significant impact on esophageal toxicity (P=0.03) as well as low doses to the controlateral lung: V5, V10 and V13 (P<0.05). CONCLUSION Helical tomotherapy is a promising technique in the multimodality treatment of malignant pleural mesothelioma. Low doses received by the contralateral lung appear to be the limiting factor. A dosimetric comparison with volumetric modulated arctherapy techniques would be interesting in this setting.
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Affiliation(s)
- J Helou
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
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9
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Vandenbos F, Figueredo M, Dumon-Gubeno MC, Nicolle I, Tarhini A, Butori C, Mouroux J. [Malignant pleural mesothelioma after radiation treatment for Hodgkin lymphoma]. Rev Pneumol Clin 2013; 69:291-293. [PMID: 23796498 DOI: 10.1016/j.pneumo.2013.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 04/15/2013] [Indexed: 06/02/2023]
Abstract
Malignant mesothelioma is a relatively uncommon malignancy. Although the pathogenesis is primarily related to asbestos, the role of ionizing radiation is more controversial. We report the case of a 41-year-old male who developed pleural mesothelioma. He had both, a prior short asbestos exposure and a thoracic radiotherapy for Hodgkin's disease 26years before. The evidence for radiotherapy as cause for mesothelioma is expanding and the diagnosis of mesothelioma in patients who had previous irradiation should be kept in mind.
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Affiliation(s)
- F Vandenbos
- Service de pneumologie, hôpital Clavary, BP 53149, 06135 Grasse cedex, France; Centre de soins de suite et de rééducation « La Maison du Mineur », 577, avenue Henri-Giraud, 06141 Vence cedex, France.
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