Intensity modulated radiation therapy after extra‐pleural pneumonectomy for malignant pleural mesothelioma is feasible without fatal pulmonary toxicity and provides good survival

Intensity modulated radiation therapy after extra‐pleural pneumonectomy for malignant pleural... 1INTRODUCTIONMalignant pleural mesothelioma (MPM) is a rare but deadly malignant neoplasm arising in the pleura with approximately 2500 cases diagnosed annually in the United States and a median survival of 12 months (median survival in most series is 4–20 months). Asbestos exposure remains the greatest risk factor with 70–80% of MPM patients having documented exposure to asbestos: men are more commonly affected than women.The management of MPM is challenging and controversial. Broadly, there is debate regarding the optimal surgical approach of extrapleural pneumonectomy (EPP) versus lung sparing approaches, such as pleurectomy and decortication (P/D). Unfortunately, regardless of the surgical approach, relapse is common after surgery and is predominantly loco‐regional with subsequent dismal outcomes. Aggressive local therapy with surgery followed by adjuvant radiation plays a major role in the multimodal management to improve local control.The delivery of radiation therapy has improved over time from 3‐D conformal techniques to intensity modulated radiation therapy (IMRT). However, initial experience with IMRT was fraught with very high rates of fatal pulmonary toxicity. The increasing experience with IMRT treatment planning and delivery has improved our understanding of acceptable lung dose constraints. Strict adherence to these published lung dose constraints in subsequent studies has resulted in http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Asia-Pacific Journal of Clinical Oncology Wiley

Intensity modulated radiation therapy after extra‐pleural pneumonectomy for malignant pleural mesothelioma is feasible without fatal pulmonary toxicity and provides good survival

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Publisher
Wiley Subscription Services, Inc., A Wiley Company
Copyright
Copyright © 2018 John Wiley & Sons Australia, Ltd
ISSN
1743-7555
eISSN
1743-7563
D.O.I.
10.1111/ajco.12680
Publisher site
See Article on Publisher Site

Abstract

1INTRODUCTIONMalignant pleural mesothelioma (MPM) is a rare but deadly malignant neoplasm arising in the pleura with approximately 2500 cases diagnosed annually in the United States and a median survival of 12 months (median survival in most series is 4–20 months). Asbestos exposure remains the greatest risk factor with 70–80% of MPM patients having documented exposure to asbestos: men are more commonly affected than women.The management of MPM is challenging and controversial. Broadly, there is debate regarding the optimal surgical approach of extrapleural pneumonectomy (EPP) versus lung sparing approaches, such as pleurectomy and decortication (P/D). Unfortunately, regardless of the surgical approach, relapse is common after surgery and is predominantly loco‐regional with subsequent dismal outcomes. Aggressive local therapy with surgery followed by adjuvant radiation plays a major role in the multimodal management to improve local control.The delivery of radiation therapy has improved over time from 3‐D conformal techniques to intensity modulated radiation therapy (IMRT). However, initial experience with IMRT was fraught with very high rates of fatal pulmonary toxicity. The increasing experience with IMRT treatment planning and delivery has improved our understanding of acceptable lung dose constraints. Strict adherence to these published lung dose constraints in subsequent studies has resulted in

Journal

Asia-Pacific Journal of Clinical OncologyWiley

Published: Jan 1, 2018

Keywords: ; ;

References

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