ABSTRACT
PURPOSE: The role played by radiation therapy after pleurectomy/decortication or surgical biopsy in malignant pleural mesothelioma is uncertain. We treated patients with accelerated hypofractionated radiotherapy using helical tomotherapy and intensity-modulated arc therapy in an attempt to keep lung toxicity to a minimum. The present study reports the feasibility and toxicity of this approach. MATERIAL AND METHODS: Between 2008 and 2012, 36 patients with malignant pleural mesothelioma underwent accelerated hypofractionated radiotherapy to the hemithorax after pleurectomy/decortication (19 patients) or biopsy (17 patients). The prescription dose was 25Gy in five fractions over 5 consecutive days. RESULTS: We observed three patients with G3 pneumonitis, five cases of grade 2 dyspnea and six cases of grade 2 cough. The median follow-up was 37 months (range: 3-54 months). The median overall survival for patients who underwent pleurectomy/decortication followed by radiotherapy was 21.6 months [95% confidence interval (95% CI): 15.5-24.1] compared to 19.4 months for patients not submitted to surgery. CONCLUSION: Treatment of intact lung with pleural intensity-modulated arc irradiation in malignant pleural mesothelioma patients with malignant pleural mesothelioma proved safe and feasible, with an acceptable rate of pneumonitis. Survival rates were encouraging for both biopsy-only and pleurectomy/decortication groups. We are currently conducting a phase II dose escalation trial in a similar patient setting to prospectively evaluate the impact of radiotherapy on toxicity, disease-free survival and overall survival.
Subject(s)
Lung Neoplasms/radiotherapy , Lung Neoplasms/surgery , Mesothelioma/radiotherapy , Mesothelioma/surgery , Pleura/surgery , Pleural Neoplasms/radiotherapy , Pleural Neoplasms/surgery , Radiation Dose Hypofractionation , Radiotherapy, Intensity-Modulated , Adult , Aged , Aged, 80 and over , Biopsy , Combined Modality Therapy , Female , Humans , Lung Neoplasms/pathology , Male , Mesothelioma/pathology , Mesothelioma, Malignant , Middle Aged , Pleural Neoplasms/pathology , Retrospective StudiesABSTRACT
In reviewing 91 cases of bronchogenic carcinoma, traditional radiology (TR) and CT patterns were compared versus surgical/pathologic findings. CT always gave clearer assessment of the mediastinum and thoracic wall invasion. In the evaluation of metastatic spread to hilar and mediastinal lymph nodes the false negative rate was higher with TR than with CT; on the other hand, there was a higher false positive rate with CT. The advantage of CT in the staging of bronchogenic carcinoma is verified and a rationalized flow-chart which includes TR, endoscopy, CT and mediastinoscopy is suggested.
Subject(s)
Carcinoma, Bronchogenic/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Adult , Aged , Carcinoma, Bronchogenic/pathology , Carcinoma, Bronchogenic/surgery , Female , Humans , Lung Neoplasms/pathology , Lung Neoplasms/surgery , Male , Mediastinal Neoplasms/pathology , Mediastinal Neoplasms/secondary , Middle Aged , Neoplasm Invasiveness , Neoplasm Staging , Pleural Neoplasms/pathology , Pleural Neoplasms/secondary , RadiographySubject(s)
Heart Rupture/etiology , Pericardium , Thoracic Injuries/complications , Adult , Aged , Heart Rupture/surgery , Humans , Male , Middle AgedABSTRACT
Respiratory function tests carried out on 98 patients with mitral valve disease are reported. The indices were correlated with the N.Y.H.A. classification and mean pulmonary artery pressure values. The patterns were similar for both types of correlation. There were early VC, RV and RV/TLC alterations. In more advanced cases, there were also reductions in DLCO, MEVS, and FEF25-75%. The result is a primarily restrictive dysventilatory picture that is clinically compatible with interstitial pulmonary fibrosis.