Extrapleural pneumonectomy, photodynamic therapy and intensity modulated radiation therapy for the treatment of malignant pleural mesothelioma

• Published in: Cancer biology & therapy 2010-09, Vol.10 (5), p.425-429
• Main Authors: Du, Kevin L., Both, Stefan, Friedberg, Josephy S., Rengan, Ramesh, Hahn, Stephen M., Cengel, Keith A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Binding; Biology; Bioscience; Calcium; Cancer; Cell; Combined Modality Therapy; Cycle; Female; Humans; Landes; Male; Mesothelioma - drug therapy; Mesothelioma - radiotherapy; Mesothelioma - surgery; Mesothelioma - therapy; Middle Aged; Organogenesis; Photochemotherapy; Pleural Neoplasms - drug therapy; Pleural Neoplasms - radiotherapy; Pleural Neoplasms - surgery; Pleural Neoplasms - therapy; Pneumonectomy; Proteins; Radiation Pneumonitis - etiology; Radiotherapy, Intensity-Modulated - adverse effects; Radiotherapy, Intensity-Modulated - methods; Respiratory Insufficiency - etiology; Thoracic Cavity - radiation effects; Treatment Outcome
• ISSN: 1538-4047; 1555-8576
• DOI: 10.4161/cbt.10.5.12616

Intensity modulated radiation therapy (IMRT) has recently been proposed for the treatment of malignant pleural mesothelioma (MPM). Here, we describe our experience with a multimodality approach for the treatment of mesothelioma, incorporating extrapleural pneumonectomy, intraoperative photodynamic therapy and postoperative hemithoracic IMRT. From 2004-2007, we treated 11 MPM patients with hemithoracic IMRT, 7 of whom had undergone porfimer sodium-mediated PDT as an intraoperative adjuvant to surgical debulking. The median radiation dose to the planning treatment volume (PTV) ranged from 45.4-54.5Gy. For the contralateral lung, V20 ranged from 1.4 - 28.5%, V5 from 42 - 100%, and MLD from 6.8 - 16.5Gy. In our series, 1 patient experienced respiratory failure secondary to radiation pneumonitis that did not require mechanical ventilation. Multimodality therapy combining surgery with increased doses of radiation using IMRT, and newer treatment modalities such as PDT, appears safe. Future prospective analysis will be needed to demonstrate efficacy of this approach in the treatment of malignant mesothelioma. Efforts to reduce lung toxicity and improve dose delivery are needed and provide the promise of improved local control and quality of life in a carefully chosen multidisciplinary approach.