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Accelerated Hemithoracic Radiation Followed by Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma

The following is a summary of an article written by Marc de Perrot, MD, MSc, et al. that was published in the October, 19, 2015 issue of The Journal of Thoracic and Cardiovascular Surgery.

Researchers at the Princess Margaret Cancer Centre and Toronto General Hospital in Canada have recently published a study evaluating a new treatment protocol for patients with resectable malignant pleural mesothelioma (MPM). This new protocol involves accelerated hemithoracic intensity-modulated radiation therapy (IMRT) followed by extrapleural pneumonectomy (EPP).

This study included a total of 62 mesothelioma patients from a time period ranging from November 2008 through October 2014. Patients were administered 25 gray (Gy) units of targeted radiation therapy for one week with an extra “boost” of 5 Gy to areas considered to be “high risk” by means of CT and PET scan results. Patients then underwent an EPP in which one lung was removed, in addition to the diseased linings of the remaining lung and heart. This procedure took place 6 (±2) days following the completion of radiation therapy.

This new protocol, which combined two pre-existing treatment approaches, resulted in extended survival rates for patients. “The median overall survival and disease-free survival was 51 and 47 months, respectively, in epithelial subtypes, compared with 10 and 8 months in biphasic subtypes.”

While EPPs are considered extremely high-risk procedures, and even controversial by some physicians who feel the risks outweigh the benefits, this study had a treatment-related mortality rate of less than 5% with 39% of patients presenting with complications directly related to treatment.

Marc de Perrot, MD, MSc, lead author of the study, along with his co-authors and colleagues, concluded that accelerated hemithoracic IMRT followed by EPP is now their “preferred approach for resectable MPM.”

This study provides further research support for those mesothelioma patients looking for the right treatment option for their particular situation, as well as research support as they consider what treatment options will provide them with extended survival outcomes.


de Perrot M, et al. Accelerated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 2015 Oct 19. pii: S0022-5223(15)01986-8.

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