How do you approach medically inoperable pleural mesothelioma confined to a single hemithorax and symptomatic for chest wall pain, not responsive to first-line systemic therapy?
E.g. right hemithorax disease from lung apex to diaphragm, no response s/p 3 cycles of cis/pem.
3 Answers
Mednet MemberInvited Expert
Radiation Oncology · University of Texas MD Anderson Cancer Center
Answered on
In these settings, our convention has been to use 20 Gy in 5 fractions. This is based on studies that have shown palliative benefit in mesothelioma with doses at or exceeding 4 Gy per fraction, and also following the phase 2 SYSTEMS trial (MacLeod JTO 2015) using the 20 Gy in 5 fraction regimen. In ...
Join for free or sign in to see the full answer
Mednet Member
Radiation Oncology · Cancer Care Centers of Brevard
Answered on · Updated on
I would consider dose escalation if possible, extrapolating from post op data. 45/15 or 50/25 with SIB to 60 as per this recent RCT, if the patient has a good PS.
Join for free or sign in to see the full answer
Mednet Member
Medical Oncology · West Virginia University Cancer Institute
Answered on
In addition to radiation option, immunotherapy can be tried as well.
Join for free or sign in to see the full answer