Intensity-Modulated Radiotherapy After Extrapleural Pneumonectomy in the Combined-Modality Treatment of Malignant Pleural Mesothelioma

被引:32
作者
Chi, Alexander [1 ]
Liao, Zhongxing [2 ]
Nguyen, Nam P. [1 ]
Howe, Carol [3 ]
Gomez, Daniel [2 ]
Jang, Si Young [1 ]
Komaki, Ritsuko [2 ]
机构
[1] Univ Arizona, Dept Radiat Oncol, Tucson, AZ 85724 USA
[2] Univ Texas MD Anderson Canc Ctr, Dept Radiat Oncol, Houston, TX 77030 USA
[3] Univ Arizona, Arizona Hlth Sci Lib, Tucson, AZ 85724 USA
关键词
Malignant pleural mesothelioma; Extrapleural pneumonectomy; IMRT; DOSE HEMITHORACIC RADIATION; PHASE-II TRIAL; TRIMODALITY THERAPY; INDUCTION CHEMOTHERAPY; HELICAL TOMOTHERAPY; MULTIMODALITY THERAPY; TARGET COVERAGE; UNITED-STATES; MANAGEMENT; PATTERNS;
D O I
10.1097/JTO.0b013e3182199819
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Introduction: Local therapy is becoming increasingly important as a part of the definitive treatment for malignant pleural mesothelioma after extrapleural pneumonectomy (EPP) because of the emergence of trimodality therapy consisted of chemotherapy, EPP, and adjuvant radiotherapy. Herein, we explore the current evidence and indications for adjuvant intensity-modulated radiotherapy (IMRT), as well as how to further improve this technique and adapt new technology in the delivering adjuvant radiotherapy in the setting of trimodality therapy. Methods: A systematic review of relevant studies identified through PubMed, ISI Web of Knowledge (Web of Science), the Cochrane Library, and the National Guideline Clearinghouse search engines was performed. Results: Local control remains poor despite the inclusion of conventional adjuvant radiation therapy in trimodality therapy. This can be improved by the delivery of adjuvant IMRT. However, IMRT can be associated with severe pulmonary toxicity if the radiation dose to the remaining lung is not kept to a very low level. This is especially true when patients are receiving chemotherapy. New advances in technology can allow for lower doses to the contralateral lung, decreased treatment delivery time, and improved target dose coverage. Conclusion: Excellent local control can be achieved through adjuvant IMRT after EPP for malignant pleural mesothelioma. Severe pulmonary toxicity may be avoided by setting stringent dose constraints for the contralateral lung. This can be aided by the advances in technology. Post-treatment surveillance may be reliably conducted by periodical [F-18]-fluorodeoxyglucose-positron emission tomography imaging.
引用
收藏
页码:1132 / 1141
页数:10
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