Surgical Treatment after Radiotherapy in Malignant Pleural Mesothelioma
Pp. 441-451 (11)
Laura Donahoe and Marc de Perrot
alignant Pleural Mesothelioma (MPM) is a diagnosis that implies a poor
prognosis and lack of effective treatment options. As a consequence of the lag time
between exposure to asbestos and onset of disease, the incidence of MPM is expected to
keep rising in the coming years. Although many treatment algorithms have been tried in
the past, mortality is still very high due to both high local recurrence rates and
development of distant disease. A new protocol was thus developed in an attempt to
improve overall survival from this disease - Surgery for Mesothelioma After Radiation
Therapy (SMART). The SMART involves a fractionated administration of 25 Gy over
seven days to the whole chest by intensity modulated radiation therapy (IMRT). A
concomitant boost of 5 Gy is also delivered to high risk volumes - based on imaging
findings (CT and PET). Within 15 days of the completion of the radiation treatment,
therapy, extra-pleural pneumonectomy is performed. This protocol may yield
satisfactory results in case of epithelial-type MPM.
Hemithoracic radiation, radiotherapy, thoracic surgery.
Toronto Mesothelioma Research Program, Toronto General Hospital Princess Margaret Cancer Center, 200 Elizabeth street, Toronto, Canada.