Author of

• 18606

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  P3.03 - Poster Session with Presenters Present (ID 473)

  • Event: WCLC 2016
  • Type: Poster Presenters Present
  • Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
  • Presentations: 1
  • Moderators:
  • Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)

  • 18646

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    P3.03-040 - Long Term Outcomes Following IMRT for Mesothelioma Post EPP and Unresectable (ID 4594)

    14:30 - 14:30  |  Author(s): A.M. Allen
    • Abstract

    Background:
    Malignant Pleural Mesothelioma (MPM) is an uncommon thoracic malignancy which remains a challenge in management. In recent years the use of surgery has been widely debated especially the use of extrapleural pneumonectomy. (EPP) Following EPP radiotherapy has been widely used to reduce local control with varied results. In patients that are not surgical candidates definitive intensity modulated radiotheapy (IMRT) based treatment has become an option in addition to systemic therapy (Zaruder et al.). We sought to report our results in a unique middle-eastern population with low-level asbestos exposure for both: IMRT – post – EPP and with IMRT used as definitive therapy for patients who were unresectable.
    
    Methods:
    Complete medical records of MPM patients (n=28) treated with IMRT at the Davidoff Center were reviewed with Helsinki committee approval. Patients were divided into two groups: post- EPP(n=17) and without surgery(n=11). Patients following EPP were treated with IMRT to 54Gy to the entire hemithorax. Patients without surgery were treated with pleural IMRT (P-IMRT) to the entire hemithorax to 54Gy. cisplatinum\pemetrexed chemotherapy was used in 18\28 patients. Patients were grouped by asbestos exposure (9/28-32%) and Mediterranean/Arabic (58%) vs. caucasian ethnicity(42%). Patients were followed for outcomes and toxicity until death.
    
    Results:
    28 patients, predominately male, (82%) were treated at a single center in Israel between 8/2007 and 3/2016. For patients post-EPP 56% received sequential chemotherapy with IMRT. 94% had epitheliod histology. 11/17 (65%) had disease progression with a median time TTP of 12 months(range 1-72mos) . 23% of remain alive without evidence of disease. Only 2/17 (11%) experienced local failure. The Median OS for this group is 23.6 months(1- 100 months) . For the 11 patients treated with definitive P-IMRT, 90% received platinum based chemotherapy. 81% were epitheliod histology. 54% have experienced progression with median TTP of 12 months. Median overall survival for the cohort is 13.5 months (range 8-49months) . Of note no episodes of grade 3 or greater radiation pneumonitis were seen in the entire cohort.
    
    Conclusion:
    This is the first Israeli report of outcomes following definitive therapy for mesothelioma. IMRT was delivered without toxicity. The local control following EPP was excellent with encouraging OS. P-IMRT can be delivered to unresectable patients with encouraging overall survival and time to progression. Further work must be done to sequence systemic therapy with IMRT.