ABSTRACT
PURPOSE: To determine the factors influencing the response to palliative radiotherapy (RT) in malignant mesothelioma of the pleura (MM). METHODS AND MATERIALS: A retrospective review was conducted of the records of all patients with mesothelioma who were referred to our institution between 1979 and 1996. A total of 227 RT series were administered to 189 patients with MM. Of these, 21 patients with chest wall nodules also received concomitant local hyperthermia. RESULTS: The median survival was 5 months from the start of RT and only 17% of patients were alive at 1 year after treatment. Chest pain and painful chest wall metastases were the main indications for RT. A higher local response rate was seen for patients treated with a 4-Gy per fraction scheme, vs. those receiving fractions of less than 4 Gy (50% vs. 39%). Pain recurrence occurred predominantly within the previous RT field, and pain recurred after a median of 69 days (range 32-363) in the group treated using 4-Gy fractions. When compared with a matched group, patients treated with combined RT and hyperthermia had higher response rates and fewer in-field recurrences. CONCLUSIONS: RT provides local palliation in at least 50% of patients with MM who were treated using a 4-Gy/fraction scheme to a median dose of 36 Gy. The low response rates with RT alone suggest that combined RT and local hyperthermia should be further evaluated in MM.
Subject(s)
Mesothelioma/radiotherapy , Pleural Neoplasms/radiotherapy , Adult , Aged , Aged, 80 and over , Analysis of Variance , Combined Modality Therapy , Dose Fractionation, Radiation , Female , Humans , Hyperthermia, Induced , Male , Mesothelioma/drug therapy , Mesothelioma/secondary , Mesothelioma/therapy , Middle Aged , Neoplasm Staging , Palliative Care , Pleural Neoplasms/drug therapy , Pleural Neoplasms/pathology , Pleural Neoplasms/therapy , Prognosis , Retrospective Studies , Treatment OutcomeABSTRACT
PURPOSE: Intratumor thermometry during hyperthermia treatment is considered important for several reasons. The morbidity that we experienced from interstitially placed catheters in deep-seated tumors gave reason to weigh the advantages and disadvantages against each other. METHODS AND MATERIALS: The available thermometry in 215 patients treated with hyperthermia for deep-seated tumors was analyzed with the aim to evaluate practically feasible intratumor measurements. The influence of intratumor measurements on the treatment procedure was assessed. RESULTS: Total 120 catheters were placed interstitially in 78 patients. Over the years, the percentage of patients with interstitial thermometry decreased considerably. Forty-nine catheters could remain in place during the whole hyperthermia treatment series. The remaining catheters had to be removed for more or less severe complications, including one fatal event. In fact, the interstitial catheters caused the most severe treatment-related morbidity. During 188 of the total 859 treatments, at least one interstitial catheter was available for thermometry. Per treatment with catheter(s) in situ, the average number of intratumor measurement sites was 6.9. The value of interstitial thermometry for power steering during treatment, to both optimize intratumor temperature distribution and prevent toxicity, appeared limited. The mean volume of the tumors with interstitial thermometry was 314 cm3, SD 325. In relation to the large tumor volumes, the thermal dose parameters calculated from the available data is considered to be of limited value. CONCLUSION: In view of the possible severe complications and the limited clinical value of the information achieved by interstitially placed thermometry catheters, interstitial thermometry was not found to routinely benefit the individual patient.
