Clinical outcome of postoperative highly conformal versus 3D conformal radiotherapy in patients with malignant pleural mesothelioma

Radiation Oncology

Oliver Riesterer²  I Frank Ciernik¹  Peter Dimmerling²  Jérôme Krayenbuehl² 

[1] Department of Radiotherapy and Radiation Oncology, Dessau Municipal Hospital, Dessau, Germany;Department of Radiation Oncology, Zurich University Hospital, Rämistrasse 100, 8091 Zurich, Switzerland

关键词: Multimodal therapy;    Intensity modulated radiotherapy;    Volumetric modulated arc therapy;    Extrapleural pneumonectomy;    Radiation therapy;    Mesothelioma;   

Others  :  814948
DOI  :  10.1186/1748-717X-9-32

 received in 2013-09-06, accepted in 2014-01-03,  发布年份 2014

【 摘 要 】

Background

Radiotherapy (RT) is currently under investigation as part of a trimodality treatment of malignant pleural mesothelioma (MPM). The introduction of highly conformal radiotherapy (HCRT) technique improved dose delivery and target coverage in comparison to 3-dimensional conformal radiotherapy (3DCRT). The following study was undertaken to investigate the clinical outcome of both radiation techniques.

Methods

Thirty-nine MPM patients were treated with neoadjuvant chemotherapy, extrapleural pneumonectomy (EPP) and adjuvant RT. Twenty-five patients were treated with 3DCRT, and 14 with HCRT (Intensity modulated radiotherapy or volumetric modulated arc therapy). Overall survival, disease free survival, locoregional recurrence and pattern of recurrence were assessed. A matched pair analysis was performed including 11 patients of each group.

Results

After matching for gender, age, histology, tumor stage and resection status, HCRT seemed superior to 3DCRT with a local relapse rate of 27.3% compared to 72.7% after 3DCRT (p = 0.06). The median time to local relapse was increased by 49% with HCRT in comparison to 3DCRT from 10.9 ± 5.4 months to 16.2 ± 3.1 months (p = 0.06). The median overall survival was 22.3 ± 15.3 months for HCRT and 21.2 ± 9.2 months for 3DCRT (p = 0.57). Recurrence analysis showed that in-field local relapses occurred in previously underdosed regions of the tumor bed in 16% of patients treated with 3DCRT and in 0% of HCRT patients.

Conclusions

The use of HCRT increases the probability of local control as compared to 3DCRT by improving target volume coverage. HCRT did not improve overall survival in this patient series due to the high rate of distant recurrences.

【 授权许可】

   
2014 Krayenbuehl et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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