Long term side effects after volumetric modulated arc therapy to the pleura in patients with malignant pleural mesothelioma

IF 4.4 2区医学 Q1 ONCOLOGY

Lung Cancer Pub Date : 2025-06-25 DOI:10.1016/j.lungcan.2025.108639

Vishruta Dumane , Juliana Runnels , Raja Flores , Andrea Wolf , Weijia Fu , Madhu Mazumdar , Thomas Marron , Jorge Gomez , Kenneth Rosenzweig

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引用次数: 0

Abstract

Purpose

Lung-sparing pleurectomy/decortication (P/D) is the primary surgical approach for malignant pleural mesothelioma (MPM), and combining it with other therapies enhances patient outcomes. This report presents the extended follow-up results of MPM patients who underwent P/D and received volumetric modulated arc therapy (VMAT).

Methods

From 2010 to 2021, 81 patients with biopsy-proven malignant pleural mesothelioma, all post-P/D with two intact lungs, were retrospectively analyzed. Some patients received either induction or post-radiation chemotherapy. The target volume was the entire hemithorax, excluding the ipsilateral lung, aiming for 50.4 Gy (1.8 Gy fractions), with a mean lung dose of <20 Gy. Kaplan-Meier analysis determined overall survival (OS) and progression-free survival (PFS). Pulmonary, cardiac, and gastrointestinal events (≥1 year follow-up) were scored using Common Terminology Criteria for Toxicity and Adverse Event Reporting version 5.0 (CTCAE V5.0).

Results

Of the 81 patients, 45 (55.6 %) had ≥1 year of follow-up, median 2.2 years (26 months). Median OS was 14.2 months (95 % CI, 12.1–21) and PFS was 9.1 months (95 % CI, 7.7–12.5). The Kaplan-Meier OS rates were 60.5 % at 1 year, 33.3 % at 2 years; PFS rates were 40.7 % at 1 year, 19.8 % at 2 years. Seven patients (8.6 %) had grade 3 radiation pneumonitis, all resolving with care, and 1 patient experienced grade 3 pericarditis. No grade 3 gastrointestinal events occurred, and no grade 4 or 5 events were seen.

Conclusions

This study represents the largest retrospective cohort and longest follow-up to date assessing the safety of VMAT. Pleural VMAT proves safe, lacking unexpected long term severe side effects. Future research including treatment plan dose prediction, and advanced deployment techniques will aim to broaden mesothelioma radiotherapy delivery.

查看原文本刊更多论文

恶性胸膜间皮瘤胸膜体积调节弧治疗后的长期副作用

目的保留胸膜切除/去皮术（P/D）是恶性胸膜间皮瘤（MPM）的主要手术方法，与其他治疗方法联合可提高患者的预后。本报告介绍了MPM患者接受P/D和体积调节电弧治疗（VMAT）的扩展随访结果。方法回顾性分析2010年至2021年活检证实的81例恶性胸膜间皮瘤患者，均为p /D后双肺完整。一些患者接受了诱导化疗或放疗后化疗。靶体积为整个半胸，不包括同侧肺，目标剂量为50.4 Gy （1.8 Gy分数），平均肺剂量为20 Gy。Kaplan-Meier分析确定总生存期（OS）和无进展生存期（PFS）。使用5.0版毒性和不良事件报告通用术语标准（CTCAE V5.0）对肺、心脏和胃肠道事件（随访≥1年）进行评分。结果81例患者中，45例（55.6%）随访≥1年，中位随访2.2年（26个月）。中位OS为14.2个月（95% CI, 12.1-21）， PFS为9.1个月（95% CI, 7.7-12.5）。Kaplan-Meier OS率1年为60.5%，2年为33.3%；PFS 1年为40.7%，2年为19.8%。7例（8.6%）患者为3级放射性肺炎，均在谨慎治疗下消退，1例患者为3级心包炎。未发生3级胃肠道事件，也未见4级或5级胃肠道事件。本研究是迄今为止评估VMAT安全性的最大的回顾性队列和最长的随访。胸膜VMAT被证明是安全的，没有意想不到的长期严重副作用。未来的研究将包括治疗计划、剂量预测和先进的部署技术，以扩大间皮瘤放疗的范围。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lung Cancer 医学-呼吸系统

CiteScore

9.40

自引率

3.80%

发文量

407

审稿时长

25 days

期刊介绍： Lung Cancer is an international publication covering the clinical, translational and basic science of malignancies of the lung and chest region.Original research articles, early reports, review articles, editorials and correspondence covering the prevention, epidemiology and etiology, basic biology, pathology, clinical assessment, surgery, chemotherapy, radiotherapy, combined treatment modalities, other treatment modalities and outcomes of lung cancer are welcome.