Hemithoracic radiation therapy after extrapleural pneumonectomy for malignant pleural mesothelioma: Toxicity and outcomes at an Australian institution.
INTRODUCTION
We aim to report the outcome of patients with malignant pleural mesothelioma who underwent extrapleural pneumonectomy (EPP) and adjuvant hemithoracic radiotherapy with or without chemotherapy at a single Australian institution.


METHOD
Between July 2004 and March 2013, 53 patients were referred for radiation treatment following EPP, of whom 49 were suitable for adjuvant treatment. Radiation treatment initially involved a 3D conformal, mixed electron/photon technique, delivering 45-50.4 Gy in 25-28 fractions (31 patients) and subsequently a nine-field intensity-modulated radiotherapy technique, delivering 50.4-54 Gy in 28-30 fractions (18 patients). Fifty-five per cent of patients also received pre-operative chemotherapy. We assessed toxicity, disease-specific and overall survival in patients who commenced radiation treatment.


RESULTS
Forty-one patients (84%) completed treatment as prescribed. Six patients stopped prematurely due to toxicity, and two with disease progression. Most patients discontinuing due to toxicity received over 90% of the prescribed dose. Common acute toxicities included nausea, fatigue, anorexia and dermatitis. Severe early toxicities were rare. Late toxicities were uncommon, with the exception of a persistent elevation in liver enzymes in those with right-sided disease. Neither clinical hepatitis nor radiation pneumonitis was documented. With a median follow up of 18.7 months, median disease-free and overall survival were 21.6 and 30.5 months, respectively, and 2-year overall survival was 57.3%.


CONCLUSION
Hemithoracic radiotherapy following EPP, although associated with significant early toxicity, is well tolerated. Most patients complete the prescribed treatment, and clinically significant late toxicities are rare.
['Bece|Andrej|A|', 'Tin|Mo Mo|MM|', 'Martin|Darren|D|', 'Lin|Robert|R|', 'McLean|Jocelyn|J|', 'McCaughan|Brian|B|']
D000328:Adult D000368:Aged D015984:Causality D015897:Comorbidity D005260:Female D006801:Humans D015994:Incidence D008175:Lung Neoplasms D008297:Male D008654:Mesothelioma D000086002:Mesothelioma, Malignant D008875:Middle Aged D009517:New South Wales D010997:Pleural Neoplasms D011013:Pneumonectomy D011832:Radiation Injuries D018714:Radiotherapy, Adjuvant D020266:Radiotherapy, Conformal D012307:Risk Factors D015996:Survival Rate D016896:Treatment Outcome
extrapleural pneumonectomy mesothelioma radiotherapy