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2015 ; 10
(ä): 267
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Long-term results in malignant pleural mesothelioma treated with neoadjuvant
chemotherapy, extrapleural pneumonectomy and intensity-modulated radiotherapy
#MMPMID26715491
Thieke C
; Nicolay NH
; Sterzing F
; Hoffmann H
; Roeder F
; Safi S
; Debus J
; Huber PE
Radiat Oncol
2015[Dec]; 10
(ä): 267
PMID26715491
show ga
INTRODUCTION: We investigated the clinical outcome and the toxicity of trimodal
therapy of malignant pleural mesothelioma (MPM) treated with neoadjuvant
chemotherapy, extrapleural pneumonectomy (EPP) and adjuvant intensity-modulated
radiotherapy (IMRT). METHODS: Chemotherapy regimens included
Cisplatin/Pemetrexed, Carboplatin/Pemetrexed and Cisplatin/Gemcitabine, followed
by EPP. 62 patients completed the adjuvant radiotherapy. IMRT was carried out in
two techniques, either step&shoot or helical tomotherapy. Median target dose was
48 Gy to 54 Gy. Toxicity was scored with the Common Terminology Criteria (CTC)
for Adverse Events. We used Kaplan-Meier method to estimate actuarial rate of
locoregional control (LRC), distant control (DC) and overall survival (OS),
measured from the date of surgery. Rates were compared using the logrank test.
For multivariate analysis the Cox proportional hazard model was used. RESULTS:
The median OS, LRC and DC times were 20.4, 31.4 and 21.4 months. The 1-, 2-,
3-year OS rates were 63, 42, 28 %, the LRC rates were 81, 60, 40 %, and the DC
rates were 62, 48, 41 %. We observed no CTC grade 4 or grade 5 toxicity.
Step&shoot and helical tomotherapy were equivalent both in dosimetric
characteristics and clinical outcome. Biphasic tumor histology was associated
with worse clinical outcome compared to epitheloid histology. CONCLUSIONS: Mature
clinical results of trimodal treatment for MPM were presented. They indicate that
hemithoracic radiotherapy after EPP can be safely administered by either
step&shoot IMRT and tomotherapy. However, the optimal prospective patient
selection for this aggressive trimodal therapy approach remains unclear. This
study can serve as a benchmark for current and future therapy concepts for MPM.
|Adult
[MESH]
|Aged
[MESH]
|Antineoplastic Combined Chemotherapy Protocols/therapeutic use
[MESH]