Sameer Jhavar MD, PhD, Presenter: Nothing to Disclose

Mehul Patel, Abstract Co-Author: Nothing to Disclose

Divya Patel, Abstract Co-Author: Nothing to Disclose

Nitika Thawani MD, Abstract Co-Author: Nothing to Disclose

Dharanipathy Rangaraj, Abstract Co-Author: Nothing to Disclose

Philip Rascoe, Abstract Co-Author: Nothing to Disclose

Scott Reznik, Abstract Co-Author: Nothing to Disclose

Alan Gowan, Abstract Co-Author: Nothing to Disclose

W Roy Smythe, Abstract Co-Author: Nothing to Disclose

Subhakar Mutyala MD, Abstract Co-Author: Nothing to Disclose

Purpose/Objective(s):Malignant Pleural Mesothelioma (MPM) is a rare cancer which is difficult to cure. Median survival ranges between 9-12 months. Published reports show Intensity-modulated radiation therapy (IMRT) after extrapleural pneumonectomy (EPP) significantly reduces local recurrence, with a potential cost of fatal pulmonary toxicity. In this study, we report our experience with IMRT following EPP for MPM at the Scott and White Hospital, Temple, Texas.Materials/Methods:We reviewed the Scott and White Hospital tumor registry for patients diagnosed with MPM between 2005 and 2012. From this group, patients who underwent EPP followed by IMRT with or without chemotherapy were selected for further analysis. Patients who received any radiotherapy at other institutions following surgery were excluded, as were those who were lost to follow up after their treatment. Medical records were reviewed to assess socio-demographic characteristics, clinical and pathological features, and treatment type. Local control, recurrence-free survival, and overall survival rates were calculated.Results:104 patients with MPM were identified between 2005 and 2012 from the hospital tumor registry. Sixteen (15%) met our inclusion criteria and were included in the analysis. All patients underwent preoperative bronchoscopy, laparoscopy, mediastinoscopy and PET followed by EPP before IMRT. Median patient age was 56 years (range, 50-76), and most (94%) were males. Ten (63%) patients had right-sided disease and six (37%) had left-sided disease. Epitheloid histology was the most common type of MPM (75%). Five (31%) patients received preoperative chemotherapy, four (25%) received adjuvant chemotherapy, and the remaining 7 (44%) received radiation only. Three (18%) patients were diagnosed with AJCC stage II disease, 10 (63%) with stage III disease, and 3 (19%) with stage IV disease. Fifteen patients received static beam IMRT and one patient received Volumetric Modulated Arc Therapy. The median dose of radiation was 45Gy in 25 fractions. The mean lung dose ranged between 5.8 - 9.3 Gy. The highest V20 (normal lung volume receiving </= 20Gy) was 7%. The mean and median follow-up was 30.4 and 28.5 months respectively (range 8.6 - 62.9 mo). Eight (50%) patients experienced disease recurrence with most (44%) recurrences occurring loco-regionally. No patients experienced fatal pulmonary toxicity during the follow up period. The mean, and median recurrence free survival was 25 and 30.1 months respectively (range, 8.6 - 32.3 mo). The mean, and median overall survival was 51.1 and 38.7 months(range, 11.9 - 62.9 mo) respectively.Conclusions:In our patient population, strict adherence to published lung dose constraints during IMRT following EPP for MPM has resulted in favorable local control without fatal pulmonary toxicity.

Jhavar, S, Patel, M, Patel, D, Thawani, N, Rangaraj, D, Rascoe, P, Reznik, S, Gowan, A, Smythe, W, Mutyala, S, Intensity-modulated Radiation Therapy Following Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma: A Single Institution Experience.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13043317.html