Follow-up/Toxicity

Question 1

What is the estimated contralat lung V20 associated with the development of fatal pneumonitis in the Tx of MPM?

Answer 1

RR was 42 for fatal pneumonitis if the V20 was >7% in the contralat intact lung based on MDACC data. (Rice DC et al., Ann Thorac Surg 2007)

Question 2

What are the dose–volume constraints for the contralat lung in RT for MPM?

Answer 2

In the remaining lung, with the V20 <7%, MLD ≤8.5 Gy, V5 <50%

Question 3

What is the dose constraint for the liver? Heart? Spinal cord? Esophagus? Kidney?

Answer 3

Liver: V30 <30%

Heart: V40 <50%

SC: V45 <10%, no volume >50 Gy

Esophagus: V55 <30%, mean <34 Gy

Kidney: V15 <20%

Question 4

What are 5 acute and long-term complications from Tx?

Answer 4

Acute: fatigue, n/v, dysphagia/odynophagia, skin reactions, cough, dyspnea, pneumonitis, infection, Lhermitte sign

Late: cardiac (pericarditis, cardiomyopathy, MI, CHF) and lung (fibrosis, pneumonitis)