Helical tomotherapy enhances local control of mesothelioma


NEW YORK (Reuters Health) - Adjuvant radiation via helical tomotherapy can achieve excellent local control of malignant pleural mesothelioma (MPM), researchers from France and Canada reported online June 12 in Lung Cancer.

"Extensive MPM disease is usually treated by extrapleural pneumonectomy (EPP) or decortication, but local relapse rates remain high in the absence of adjuvant treatment," Dr. Philippe Giraud from Paris Descartes University, Paris, France, told Reuters Health in an email.

MPM is a rare disease with limited options. Helical tomotherapy, a new intensity-modulated radiotherapy (IMRT) technique in which radiation is delivered slice by slice, "is a useful and powerful tool to prevent local relapse in MPM without causing unacceptable toxicity," Dr. Giraud said, adding that he believes helical tomotherapy after EPP could become first-line therapy for patients with normal or close to normal performance status.

Dr. Giraud and colleagues reviewed clinical outcomes of 24 patients with MPM treated with adjuvant radiotherapy delivered by helical tomotherapy, with an average follow-up of seven months. All but one had undergone EPP.

In most patients, toxicity was limited to grade 1-2 side effects, including redness of the skin, light cough or dyspnea, fatigue, nausea, and odynophagia. There was no evidence of radiotherapy-related long-term side effects in 11 patients followed for more than six months.

Slightly more than half the patients (51.8%) were disease free at 24 months after diagnosis. Eight patients had disease-free survival exceeding a year, and three patients remained disease-free for more than two years.

The relapse rate was 30%. Two local relapses were accompanied by distant metastasis.

Two patients died as a result of their tumor relapse, and two other patients died from pulmonary events possibly related to pre-existing lung toxicity. Eleven patients survived more than one year, and three were alive at two years. The median survival was estimated at 36 months.

"MPM still is a difficult cancer with poor prognosis even though it is treated with aggressive multimodality treatment," the researchers note. "With extensive surgery, modern radiotherapy, and adjuvant chemotherapy, excellent local control can be obtained, even though the impact on disease-free survival and overall survival of this multimodality strategy needs further clarification."

By Will Boggs MD

Source: http://bit.ly/ogdK99

Lung Cancer 2011.

Last Updated: 2011-07-13 16:09:11 -0400 (Reuters Health)

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