PET-guided dose escalation tomotherapy in malignant pleural mesothelioma |
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Authors: | Andrei Fodor MD Claudio Fiorino Italo Dell��Oca Sara Broggi Marcella Pasetti Giovanni Mauro Cattaneo Luigi Gianolli Riccardo Calandrino Nadia Gisella Di Muzio |
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Institution: | Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy. fodor.andrei@hsr.it |
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Abstract: | Purpose To test the feasibility of salvage radiotherapy using PET-guided helical tomotherapy in patients with progressive malignant pleural mesothelioma (MPM). Patients and Methods A group of 12 consecutive MPM patients was treated with 56 Gy/25 fractions to the planning target volume (PTV); FDG-PET/CT simulation was always performed to include all positive lymph nodes and MPM infiltrations. Subsequently, a second group of 12 consecutive patients was treated with the same dose to the whole pleura adding a simultaneous integrated boost of 62.5 Gy to the FDG-PET/CT positive areas (BTV). Results Good dosimetric results were obtained in both groups. No grade 3 (RTOG/EORTC) acute or late toxicities were reported in the first group, while 3 cases of grade 3 late pneumonitis were registered in the second group: the duration of symptoms was 2?C10 weeks. Median overall survival was 8 months (1.2?C50.5 months) and 20 months (4.3?C33.8 months) from the beginning of radiotherapy, for groups I and II, respectively (p = 0.19). A significant impact on local relapse from radiotherapy was seen (median time to local relapse: 8 vs 17 months; 1-year local relapse-free rate: 16% vs 81%, p = 0.003). Conclusions The results of this pilot study support the planning of a phase III study of combined sequential chemoradiotherapy with dose escalation to BTV in patients not able to undergo resection. |
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