Hemithoracic Intensity-modulated Radiotherapy Using Helical Tomotherapy for Patients after Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma
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概要
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Postoperative hemithoracic irradiation is regarded as an important part of the curative treatment for resectable malignant pleural mesothelioma (MPM). Because the clinical target volume in postoperative MPM is irregular and surrounded by dose-limiting critical structures, intensity-modulated radiation therapy (IMRT) is thought to be suitable. However, postoperative hemithoracic IMRT remains experimental due to a high incidence of fatal pneumonitis. Therefore, a Phase I dose escalation study for hemithoracic IMRT using helical tomotherapy was planned, and the results of the first three patients are herein reported because this technique may provide benefits to such patients. For 3 patients with postoperative MPM, who were treated by extrapleural pneumonectomy (EPP), a radiation dose of 45.0 Gy in 25 fractions was given to cover 95% of the PTV. The lung V5s of the three patients were 14.3%, 10.0%, and 31.3%, respectively. The V5s of the present plans was smaller than that of the recent IMRT planning studies. The lung V20s of these patients were 2.4%, 2.2%, and 4.3%, respectively. Their MLDs were 4.3 Gy, 3.4 Gy, and 5.8 Gy, respectively. The follow-up periods of the patients were 26, 14 and 9 months from initiation of IMRT, respectively. All patients were alive, although local and contralateral recurrences had developed in 1 patient. Only 1 patient had Grade 2 acute esophagitis and nausea. There was no treatment-related pneumonitis. Hemithoracic IMRT using helical tomotherapy may play a crucial role in adjuvant treatment for MPM after EPP.
著者
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Ando Yoshitaka
Hidaka Hospital
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Ebara Takeshi
Department Of Health Science Of Working Life And Environment Nagoya City University Graduate School
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OKAMOTO Masahiko
Department of Radiation Oncology, Gunma University Graduate School of Medicine
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Nakano Takashi
Department Of Anatomy Aichi Medical University
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KAMINUMA Takuya
Department of Radiation Oncology, Gunma University Graduate School of Medicine
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Kaminuma Takuya
Department Of Radiation Oncology Gunma University Graduate School Of Medicine
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Kawamura Hidemasa
Department Of Radiation Oncology Gunma University Graduate School Of Medicine
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Okamoto Masahiko
Department Of Cardiovascular Surgery Kawasaki Municipal Hospital
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Yoshida Daisaku
Department Of Radiation Oncology Gunma University Graduate School Of Medicine
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Takahashi Takeo
Department Of Anesthesiology Sapporo Medical College And Hospital
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Kobayashi Kunihiko
Department Of Agricultural Chemistry Faculty Of Agriclture Yamaguchi University
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Sakaguchi Hirozo
Respiratory Surgery Saitama International Medical Center
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EBARA Takeshi
Department of Radiation Oncology, Gunma University Graduate School of Medicine
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OKUBO Yu
Department of Radiation Oncology, Gunma University Graduate School of Medicine
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NAKANO Takashi
Department of Radiation Oncology, Gunma University Graduate School of Medicine
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KOBAYASHI Kunihiko
Department of Respiratory Medicine, Saitama International Medical Center
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