Intensity-modulated radiotherapy after extrapleural pneumonectomy in the combined-modality treatment of malignant pleural mesothelioma

Alexander Chi, Zhongxing Liao, Nam P. Nguyen, Carol Howe, Daniel Gomez, Si Young Jang, Ritsuko Komaki

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

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 [18F]-fluorodeoxyglucose-positron emission tomography imaging.

Original languageEnglish (US)
Pages (from-to)1132-1141
Number of pages10
JournalJournal of Thoracic Oncology
Volume6
Issue number6
DOIs
StatePublished - Jun 2011

Fingerprint

Intensity-Modulated Radiotherapy
Pneumonectomy
Adjuvant Radiotherapy
Lung
Technology
Therapeutics
Library Science
Drug Therapy
Search Engine
Fluorodeoxyglucose F18
Malignant Mesothelioma
PubMed
Positron-Emission Tomography
Radiotherapy
Guidelines
Radiation

Keywords

  • Extrapleural pneumonectomy
  • IMRT
  • Malignant pleural mesothelioma

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

Cite this

Intensity-modulated radiotherapy after extrapleural pneumonectomy in the combined-modality treatment of malignant pleural mesothelioma. / Chi, Alexander; Liao, Zhongxing; Nguyen, Nam P.; Howe, Carol; Gomez, Daniel; Jang, Si Young; Komaki, Ritsuko.

In: Journal of Thoracic Oncology, Vol. 6, No. 6, 06.2011, p. 1132-1141.

Research output: Contribution to journalArticle

Chi, Alexander ; Liao, Zhongxing ; Nguyen, Nam P. ; Howe, Carol ; Gomez, Daniel ; Jang, Si Young ; Komaki, Ritsuko. / Intensity-modulated radiotherapy after extrapleural pneumonectomy in the combined-modality treatment of malignant pleural mesothelioma. In: Journal of Thoracic Oncology. 2011 ; Vol. 6, No. 6. pp. 1132-1141.
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