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Nakanishi-Imai M, Murai T, Onishi M, Mouri A, Komiyama T, Omura M, Kudo S, Miyamoto A, Hoshino M, Ogawa S, Ohashi S, Koizumi M, Omagari J, Mayahara H, Karasawa K, Okumura T, Shibamoto Y. Survey of malignant pleural mesothelioma treatment in Japan: Patterns of practice and clinical outcomes in tomotherapy facilities. J Radiat Res 2022; 63:281-289. [PMID: 35138408 PMCID: PMC8944311 DOI: 10.1093/jrr/rrab127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/17/2021] [Indexed: 05/28/2023]
Abstract
We conducted a nationwide survey of tomotherapy for malignant pleural mesothelioma (MPM) in Japan. Fifty-six facilities were surveyed and data on 31 patients treated curatively between 2008 and 2017 were collected from 14 facilities. Twenty patients received hemithorax irradiation after extrapleural pneumonectomy (EPP) (first group). Five patients received irradiation without EPP (second group), while six received salvage radiotherapy for local recurrence (salvage group). Among the seven patients not undergoing EPP, five (four in the second group and one in the salvage group) were treated with lung sparing pleural irradiation (LSPI) and two with irradiation to visible tumors. Two-year overall survival (OS) rates in the first and second groups were 33% and 60%, respectively (median, 13 vs 30 months, P = 0.82). In the first and second groups, 2-year local control (LC) rates were 53 and 67%, respectively (P = 0.54) and 2-year progression-free survival (PFS) rates were 16% and 60%, respectively (P = 0.07). Distant metastases occurred in 15 patients in the first group and three in the second group. In the salvage group, the median OS was 18 months. Recurrence was observed in the irradiated volume in four patients. The contralateral lung dose was higher in LSPI than in hemithorax irradiation plans (mean, 11.0 ± 2.2 vs 6.1 ± 3.1 Gy, P = 0.002). Grade 3 or 5 lung toxicity was observed in two patients receiving EPP and hemithorax irradiation, but not in those undergoing LSPI. In conclusion, outcomes of EPP and hemithorax irradiation were not satisfactory, whereas LSPI appeared promising and encouraging.
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Affiliation(s)
- Mikiko Nakanishi-Imai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan
- Department of Radiology, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, 466-8650, Japan
| | - Taro Murai
- Corresponding author. Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; Phone: (+81)52-853-8276; Fax: (+81)52-852-5244;
| | | | - Atsuto Mouri
- Saitama Medical University International Medical Center Comprehensive Cancer Center, Department of Respiratory Medicine, Hidaka, 350-1298, Japan
| | - Takafumi Komiyama
- Department of Radiology, Faculty of Medicine, University of Yamanashi, Chuo, 409-3898, Japan
| | - Motoko Omura
- Department of Radiation Oncology, Shonan Kamakura General Hospital, Kamakura, 247-8533, Japan
| | - Shigehiro Kudo
- Department of Radiation Oncology, Saitama Cancer Center, Saitama, 362-0806, Japan
| | - Akihiko Miyamoto
- Hokuto Hospital Department of Radiation Therapy, Obihiro, 080-0833, Japan
| | - Masaru Hoshino
- Northern Fukushima Medical Center, Date, 960-0502, Japan
| | - Shinichi Ogawa
- Department of Radiation Oncology Kizawa Memorial Hospital, Minokamo, 505-8503, Japan
| | - Shizuko Ohashi
- Department of Radiology, Fukui-ken Saiseikai Hospital, Fukui, 918-8503, Japan
| | - Masahiko Koizumi
- Department of Radiology, Nozaki Tokushukai Hospital, Daito, 574-0074, Japan
| | - Junichi Omagari
- Department of Radiology, Koga Hospital 21, Fukuoka, 839-0801, Japan
| | - Hiroshi Mayahara
- Department of Radiation Oncology, Kobe Minimally-invasive Cancer Center, Kobe, 650-0046, Japan
| | | | - Toshiyuki Okumura
- Department of Radiology, Mito Kyodo General Hospital, Mito, 310-0015, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan
- Narita Memorial Proton Center, Toyohashi, 441-8021, Japan
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Dumane VA, Tam J, Lo YC, Rosenzweig KE. RapidPlan for Knowledge-Based Planning of Malignant Pleural Mesothelioma. Pract Radiat Oncol 2020; 11:e219-e228. [PMID: 32562788 DOI: 10.1016/j.prro.2020.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/19/2020] [Accepted: 06/08/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE Treatment planning for malignant pleural mesothelioma is a challenging task due to the relatively large size of the target and the need to spare critical organs that overlap with or are within the target volume. We aimed to develop a knowledge-based model using RapidPlan (RP) for patients with 2 intact lungs. METHODS AND MATERIALS Data from 57 patients treated with volumetric modulated arc therapy were chosen for training the dose estimation model at a single dose level. The prescription dose was 50.4 Gy in 1.8 Gy fractions. The model was validated on 23 new patients by comparing the clinical plan to the RP. Time taken to plan the RP was compared with that for the clinical plan. RESULTS For similar target coverage and plan inhomogeneity, RP significantly improved the sparing of the contralateral lung, heart, stomach, esophagus, and ipsilateral kidney. On average, the contralateral lung V5 Gy and V10 Gy were reduced by 13.9% (P < .001) and 7.9% (P < .001), respectively. The mean heart dose was reduced by 5 Gy (P < .001) and V30 Gy by 9.1% (P < .001). Mean dose to the stomach and esophagus were both reduced by 5 Gy (P < .001), and the ipsilateral kidney V18 Gy by 4.1% (P < .001). Mean total lung dose was reduced by 0.8 Gy with RP, which enabled an increase in prescription dose by 1 fraction Absolute volume of ipsilateral lung was adequately spared by both techniques, while sparing of all other organs, namely the cord, liver, and bowel, was not compromised with RP. Time taken with RP was 20 minutes, 45 seconds versus at least 4 hours for an experienced treatment planner. CONCLUSIONS The RP model for malignant pleural mesothelioma showed improved sparing of critical organs with a reduced treatment planning time and increased prescription dose.
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Affiliation(s)
- Vishruta A Dumane
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - James Tam
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yeh-Chi Lo
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kenneth E Rosenzweig
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
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