Radiotherapy of the pleural cavity in patients with primary and secondary malignancies of the pleura

Our plain-English summary of Radiotherapy of the pleural cavity in patients with primary and secondary malignancies of the pleura, by D. Georgiev, M. Jankova, B. Krastev, et al (Reports of Practical Oncology and Radiotherapy, 2024).

The study

• Authors: D. Georgiev, M. Jankova, B. Krastev, S. Bilyukova
• Journal: Reports of Practical Oncology and Radiotherapy
• Published: 2024;29(4):509-515
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Although there have been various attempts to find appropriate treatment from best conservative care to multimodal treatments, curative outcomes remain poor.

Materials And Methods: 30 patients with primary and secondary malignant tumors of the pleura were treated in the Radiotherapy Clinic of USHATO during the period from December 2016 to April 2023. Video-assisted thoracoscopic surgery (VATS) and talc pleurodesis was performed in 18 patients (60%). In all patients, radiotherapy for the pleura was performed on a helical tomotherapy machine. In 21 patients (70%), normal fractionated radiotherapy was performed at daily dose of 1.8-2 Gy to total dose of 40 Gy (5 times a week), and in 6 patients (20%), integrated surdosage to 50 Gy was also performed for visible lesions. Hypofractionated radiotherapy (10 fractions of 3 Gy and 4 fractions of 4 Gy) was performed in 3 (10%) patients.

Results: Patients were followed up from 1 month to 57 months (median 14 months) or until death. The observed median survival for all patients was 19.2 months [95% confidence interval (CI): 11.5-26.9] (Fig. 3). The 1-, 2- and 3-year survival rates were 40%, 23% and 7% of patients, respectively. Malignant mesothelioma patients had 1-, 2- and 3-year survival rates of 31%, 10% and 0%, respectively. The 1-, 2-, and 3-year survival rates for patients with secondary malignancies were 54%, 45%, and 18%, respectively.

Conclusion: Our results suggest that helical tomotherapy is a feasible therapeutic option for patients with malignant mesothelioma or malignant secondary pleural involvement with a reasonable toxicity profile relative to other unaffected lung.

© 2024 Greater Poland Cancer Centre.

In plain English

This article described one radiotherapy clinic's experience in Sofia, Bulgaria, treating 30 patients with primary or secondary malignant pleural tumors between December 2016 and April 2023. Nineteen had malignant mesothelioma. The other 11 had cancers that started elsewhere, such as the breast, cervix or lung, and spread to the pleura. Asbestos exposure was not reported. All received pleural radiotherapy on a helical tomotherapy machine, most to 40 Gy in total. Eighteen also had VATS and talc pleurodesis. Median survival for all patients was 19.2 months (95% CI 11.5 to 26.9). For mesothelioma patients it was 10.1 months (95% CI 6.2 to 14.1), with 1-, 2- and 3-year survival of 31%, 10% and 0%. For secondary pleural tumors it was 34.7 months (95% CI 19.2 to 50). In the authors' analysis, mesothelioma and age over 61 were linked to shorter survival. All patients had short-term side effects, the most severe being grade 2 to 3 radiation pneumonitis and tracheitis. The authors concluded that their results suggest helical tomotherapy is feasible, with a reasonable toxicity profile relative to the unaffected lung.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Single-center report of treatment experience (case series), with survival estimated by the Kaplan-Meier method and prognostic factors examined by Cox regression and log-rank test
• Who was studied: 30 patients with primary or secondary malignant tumors of the pleura, treated at the Radiotherapy Clinic of USHATO, Sofia, Bulgaria, from December 2016 to April 2023. They were aged 42 to 78 (mean 61.9); 16 were men and 14 women. 19 (63.3%) had malignant mesothelioma; the rest had pleural involvement from other primary cancers (breast, cervix, lung, other).
• Exposure: The article did not report patients' asbestos exposure; asbestos is mentioned only in the introduction. The treatment studied was radiotherapy of the pleura on a helical tomotherapy machine. 21 patients (70%) received 1.8 to 2 Gy daily to a total of 40 Gy, 5 times a week. 6 patients (20%) also received an integrated boost to 50 Gy for visible lesions. 3 patients (10%) received hypofractionated radiotherapy (10 fractions of 3 Gy, or 4 fractions of 4 Gy). 18 patients (60%) had VATS and talc pleurodesis.
• Main results:
  • All 30 patients: median survival 19.2 months (95% CI: 11.5–26.9); follow-up ranged from 1 to 57 months (median 14 months).
  • All patients: 1-, 2- and 3-year survival rates of 40%, 23% and 7%.
  • Malignant mesothelioma patients (n=19): median survival 10.1 months (95% CI: 6.2–14.1); 1-, 2- and 3-year survival rates of 31%, 10% and 0%.
  • Patients with secondary pleural malignancies (n=11): median survival 34.7 months (95% CI: 19.2–50); 1-, 2- and 3-year survival rates of 54%, 45% and 18%.
  • In univariate analysis, histology (mesothelioma versus other, p = 0.005) and age (61 or under: 26.9 months versus over 61: 9.4 months, p = 0.033) were associated with overall survival. Sex, neoadjuvant chemotherapy and fractionation did not show a statistically significant influence.
  • Acute reactions occurred in all patients: skin redness (cutaneous erythema), grade 2 to 3 radiation pneumonitis, grade 1 to 2 esophagitis and grade 2 to 3 tracheitis. No more severe acute reactions were observed. Late reactions were grade 1 pulmonitis, grade 1 to 2 pulmofibrosis and grade 2 chest wall fibrosis.
  • Mean radiation dose to the opposite lung averaged 5.4 Gy. Mean dose to the same-side lung outside the target volume, at a distance of 0.5 cm, was 24.1 Gy.
• The authors' conclusion: The authors concluded that their results suggest helical tomotherapy is a feasible therapeutic option for patients with malignant mesothelioma or malignant secondary pleural involvement, with a reasonable toxicity profile relative to the unaffected lung. They added that further technical advances and standardized treatment concepts are needed.
• Limitations the authors state:
  • The authors noted that, because these diseases are rare, available studies are limited and further in-depth studies are needed.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Cavity, Pleura, Video-Assisted Thoracoscopic Surgery (VATS), Talc Pleurodesis, Median Overall Survival, confidence interval, Mesothelioma.

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