Effect of hemithorax irradiation alone or combined with doxorubicin and cyclophosphamide in 47 pleural mesotheliomas: a nonrandomized phase II study

In order to assess the value of radiotherapy in the treatment of pleural mesotheliomas, we studied tumour response and survival after hemithorax irradiation alone, or radiotherapy combined with doxorubicin and cyclophosphamide chemotherapy

C-J. Lindén

2003

Scholarcy highlights

  • Forty seven patients with pleural mesotheliomas received irradiation of the diseased hemithorax at 8 MV photons to a total dose of 40 Gy, administered in 20 daily fractions of 2 Gy for 5 days a week
  • To be included in the study, a patient had to fulfil the following requirements: 1) a histologically proven diagnosis of pleural mesothelioma based on a biopsy of the pleural tumour; 2) a performance index of 70 or more according to the Karnofsky scale ; 3) an age of less than 80 yrs for radiotherapy and an age of less than 70 yrs for combined therapy a calculated postirradiation vital capacity exceeding 1.5 L, after an expected total loss of gas exchange function in the irradiated lung; 5) normal arterial blood gas values with the patient examined in the supine position; 6) normal haematological, hepatic, renal, neurological and cardiovascular functions; 7) proper function of the contralateral kidney as examined by intravenous renography; and 8) informed consent for participation in the study
  • Forty seven patients with a pleural mesothelioma were included in the study and received hemithorax irradiation on the diseased pleural cavity
  • Active pneumonitis requiring corticosteroid treatment was regarded as a contraindication for supplementary CT, since doxorubicin is known to activate radiation-induced pneumonitis, a fact which was initially overlooked in this study
  • We found that moderate high-dose hemithorax irradiation and supplementary chemotherapy produced low rates of shortlived tumour response in pleural mesotheliomas
  • Radiotherapy alone or in combination with doxorubicin and cyclophosphamide was unable in every case to prevent the fatal progression of the disease
  • We found that the hemithorax irradiation of pleural mesotheliomas with a moderately high dose of radiation is not useful, since it did not alleviate pain, produced little or no objective tumour response, did not affect survival outcome and was in all of the cases unable to halt the relentless progression of the disease

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