Irradiation of hemithorax by tomotherapy in advanced stage malignant mesothelioma patients: Evaluation of four cases

Abstract

Objective: In this study, the efficacy and toxicity of palliative hemithorax radiotherapy administered to the malignant pleural mesothelioma (MPM) patients was evaluated when extra pulmonary pneumonectomy could not be done and disease had progressed under chemotherapy. Material and Methods: Four patients who were admitted to our clinic between June 2010- December 2011 and treated with image guided intensity modulated hemithorax radiotherapy were prospectively evaluated. Except one patient with malign thymic carcinoma who had extensive pleural and pericardial involvement, all other patients had diagnosis of advanced stage MPM. All of the patients had disease progression during 6-15 courses of different chemotherapy protocols, and were referred to our clinic for the purpose of pain palliation. Median 52 Gy (48-54 Gy) hemithorax radiotherapy with 2 Gy daily fractions was delivered by using helical tomotherapy to the target volumes which were delineated with the help of positron emission tomography fusion. Results: All patients had long-term pain palliation which lasted 6-14 months. No radiotherapy related mortalities were seen, and toleration of the therapy was generally good. Two patients had grade 1, two patients had grade 2 esophagitis and two patients had grade 1, two patients had grade 2 dermatitis during RT. One patient developed grade 3 radiation pneumonitis, and had a prompt improvement with steroid therapy 3 months after the completion of the RT. Conclusion: The curative therapy of advanced stage MPM is not possible with the current techniques and knowledge, but hemithorax radiotherapy may have a role in pain palliation. © 2014 by Türkiye Klinikleri.