Clinical outcome of postoperative highly conformal versus 3D conformal radiotherapy in patients with malignant pleural mesotheliomaReport as inadecuate

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Radiation Oncology

, 9:32

Clinical Radiation Oncology


BackgroundRadiotherapy RT is currently under investigation as part of a trimodality treatment of malignant pleural mesothelioma MPM. The introduction of highly conformal radiotherapy HCRT technique improved dose delivery and target coverage in comparison to 3-dimensional conformal radiotherapy 3DCRT. The following study was undertaken to investigate the clinical outcome of both radiation techniques.

MethodsThirty-nine MPM patients were treated with neoadjuvant chemotherapy, extrapleural pneumonectomy EPP and adjuvant RT. Twenty-five patients were treated with 3DCRT, and 14 with HCRT Intensity modulated radiotherapy or volumetric modulated arc therapy. Overall survival, disease free survival, locoregional recurrence and pattern of recurrence were assessed. A matched pair analysis was performed including 11 patients of each group.

ResultsAfter matching for gender, age, histology, tumor stage and resection status, HCRT seemed superior to 3DCRT with a local relapse rate of 27.3% compared to 72.7% after 3DCRT p = 0.06. The median time to local relapse was increased by 49% with HCRT in comparison to 3DCRT from 10.9 ± 5.4 months to 16.2 ± 3.1 months p = 0.06. The median overall survival was 22.3 ± 15.3 months for HCRT and 21.2 ± 9.2 months for 3DCRT p = 0.57. Recurrence analysis showed that in-field local relapses occurred in previously underdosed regions of the tumor bed in 16% of patients treated with 3DCRT and in 0% of HCRT patients.

ConclusionsThe use of HCRT increases the probability of local control as compared to 3DCRT by improving target volume coverage. HCRT did not improve overall survival in this patient series due to the high rate of distant recurrences.

KeywordsMesothelioma Radiation therapy Extrapleural pneumonectomy Volumetric modulated arc therapy Intensity modulated radiotherapy Multimodal therapy Electronic supplementary materialThe online version of this article doi:10.1186-1748-717X-9-32 contains supplementary material, which is available to authorized users.

Jérôme Krayenbuehl, Peter Dimmerling contributed equally to this work.

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Author: Jérôme Krayenbuehl - Peter Dimmerling - I Frank Ciernik - Oliver Riesterer


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