Important Studies

Question 1

Adjuvant RT?

Answer 1

SAKK17/04 (Stahel et al, Lancet Oncol, 2015): Malignant pleural mesothelioma, resectable, stages T1-3, N0-2, M0. Phase II randomized. 3 cycles of cis/pemetrexed –> EPP –> If macroscopic resection –>→RT vs. →no RT.
34% received an objective response
Of those who had surgery, complete macroscopic resection in 64%
Median total RT dose 55.9 Gy
Median LR-RFS 7.6 mos vs. 9.4 mos with RT
RT grade ≥3 AE N&V 11%, esophagitis 7%, pneumonitis 7%”
Findings did not support the use of hemithoracic radiotherapy after neoadjuvant chemotherapy and EPP.

Question 2

Prophylactic RT to tracts?

Answer 2

SMART (Clive et al, Lancet Oncol, 2016): Mesothelioma patients who underwent large bore pleural interventions. Immediate vs. deferred RT (for later mets) to tracts 21 Gy/ 3 fx. Incidence of procedure tract metastasis: 9% vs. 16%
There is a trend to benefit of immediate RT to procedure tracks in mesothelioma, but the results were nonsignificant and do not support routine use.