HIGH DOSE RADIOTHERAPY IN THE TREATMENT OF PLEURAL MESOTHELIOMA AFTER

PLEURECTOMY/DECORTICATION OR BIOPSY: LONG TERM FOLLW UP, ACUTE AND LATE TOXICITY

Parisi E, Romeo A, Ghigi G, Delmonte A, Dipalma B, Micheletti S, Neri E, Sarnelli A, Arienti C, Polico R.IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori

Meldola (FC) ITALY

Digital Poster Discussion 12 Lung 2 - Locally Advanced Disease and Imaging

Presentation No. 1143 Abstract 2050Monitor number: 10

Corresponding author: Antonino Romeo, MD, IRST IRCCS Meldola FC (ITA),

t.romeo@libero.it - a.romeo@irst.emr.it

PurposeIn patients with MPM (Malignant Pleural Mesothelioma) the role of radiation therapy in intact lung after pleurectomy/decortication (P/D), or after the biopsy is uncertain. We have implemented a technique that employs the intensity modulated arch therapy (IMAT) and accelerated hypofractionated schedule of radiotherapy to treat them while reducing the lung toxicity (IRST protocol 162.07).

Patients • 7 female-29 male; median age 70 ys (44-85), median FU 37months (range 7-54);• CLINICAL STAGE : I (11 pts); II (4 pts); III (14 pts); IV (7 pts);•19 pts underwent RT after pleurectomy/decortication; 17 pts underwent RT after biopsy ;

Key words: Malignant pleural mesothelioma, pleurectomy/decortication, accelerated hypofractionation radiotherapy, Helical Tomotherapy.

Objective: •To evaluate the feasibility and the efficacy;•To evaluate acute and late toxicity;•To evaluate overall survival

left lung

Acute toxicity(n:36)

G1 G2 G3 G4

Dyspnea 24 (66%)

4 (11%) - -

Cough 13 (36%)

5 (14%) - -

Fever 2 (5%)

- -

Esophagitis 3 (8%)

- -

Fatigue 5 (14%)

- -

Pneumonitis 35 (97%)

1 (3%) -

Latetoxicity(n:36)

G1 G2 G3 G4

Dyspnea 8 (22%)

1 (3%)

- -

Cough - 1 (3%)

- -

Pneumonitis 15 (42%)

1(3%)

-

36 pts studied for acute and late toxicity

0.00

0.20

0.40

0.60

0.80

1.00

OS

0 6 12 18 24 30 36months

Overall survival

TAKE HOME MESSAGE

The hypofractionation protocols are possible thanks to new technologies

In our experience was mandatory the maximum sparing of healthy lung (never exceeded the V5/5 ratio)

With similar rates of efficacy a shortened treatment time interval would reduce overall treatment costs and improve patient compliance.

As high grade (acute and late) toxicity was not observed, there is a margin to enhance the dose to T and N

N. patients

N. events

(%)

Median OS

(95% CI)

NO SURG 17 13 (76.5) 19.4 (12.6-24.1)

SURG 19 12 (63.2) 21.6 (13.3-29.5)

No Surgery

Surgery