Journal of Modern OncologyJournal of Modern OncologyСовременная онкология1815-14341815-1442LLC Obyedinennaya Redaktsiya6116610.26442/18151434.2020.4.200255CLINICAL ONCOLOGYКЛИНИЧЕСКАЯ ОНКОЛОГИЯResearch ArticleThe role of radiation therapy in the treatment of patients with pleural mesotheliomaРоль лучевой терапии в лечении больных мезотелиомой плеврыhttps://orcid.org/0000-0002-5570-684XBorisovaTatiana N.БорисоваТатьяна Николаевна
Russian Federation

Senior Res. Officer

ст. науч. сотр. отд-ния радиотерапии

tborisova111@gmail.comhttps://orcid.org/0000-0001-8965-8172TkachevSergey I.ТкачевСергей Иванович
Russian Federation

D. Sci. (Med.), Prof.

д-р мед. наук, проф., вед. науч. сотр. отд-ния радиотерапии

tborisova111@gmail.comhttps://orcid.org/0000-0003-1958-7262IvanovStanislav M.ИвановСтанислав Михайлович
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук, ст. науч. сотр. отд-ния радиотерапии

tborisova111@gmail.comhttps://orcid.org/0000-0002-6835-5567AlievaSevil B.АлиеваСевил Багатуровна
Russian Federation

D. Sci. (Med.)

д-р мед. наук, вед. науч. сотр. отд-ния радиотерапии

tborisova111@gmail.comhttps://orcid.org/0000-0002-7204-370XTrofimovaOxana P.ТрофимоваОксана Петровна
Russian Federation

D. Sci. (Med.)

д-р мед. наук, вед. науч. сотр. отд-ния радиотерапии

tborisova111@gmail.comhttps://orcid.org/0000-0002-8062-570XGlebovskayaValeria V.ГлебовскаяВалерия Владимировна
Russian Federation

D. Sci. (Med.)

д-р мед. наук, ст. науч. сотр. отд-ния радиотерапии

tborisova111@gmail.comhttps://orcid.org/0000-0002-6244-4294BrederValeriy V.БредерВалерий Владимирович
Russian Federation

D. Sci. (Med.)

д-р мед. наук, вед. науч. сотр. отд-ния клинических биотехнологий

tborisova111@gmail.comhttps://orcid.org/0000-0002-3094-362XLaktionovKonstantin K.ЛактионовКонстантин Константинович
Russian Federation

D. Sci. (Med.)

д-р мед. наук, проф., зав. отд-нием клинических биотехнологий

tborisova111@gmail.comhttps://orcid.org/0000-0002-3094-362XMarinovDimitr T.МариновДимитр Тодорович
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук, вед. науч. сотр. отд-ния амбулаторных методов диагностики и лечения

tborisova111@gmail.comhttps://orcid.org/0000-0003-0104-9087AbdullaevAmir G.АбдуллаевАмир Гусейнович
Russian Federation

D. Sci. (Med.)

д-р мед. наук, вед. науч. сотр. торакального отд-ния, торако-абдоминального отд.

tborisova111@gmail.comBlokhin National Medical Research Center of OncologyФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России311220202241091141702202117022021Copyright ©; 2020, Consilium MedicumCopyright ©; 2020, ООО "Консилиум Медикум"2020Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc/4.0https://modernonco.orscience.ru/1815-1434/article/view/61166

Pleural mesothelioma (PM) remains a disease with a poor prognosis, despite the use of the newest achievements of multimodal treatment. Radiation therapy for PM is traditionally used in some directions: in radical treatment as a part of a three-modal approach, for reducing the risk of chest metastasis in areas of invasive interventions and during palliative treatment. The lack of reliable randomized trials has led to an absence of consensus about the optimal radical treatment strategy. Mordern global recommendations for the treatment of PM are controversial regarding the use of adjuvant radiotherapy in multimodal treatment. Although the role of radiation therapy in the treatment of PM remains unclear, significant successes in planning and conducting radiotherapy are showing that long-term survival can be achieved for these patients, for whom, until recently, only palliative treatment was considered as appropriate treatment. For many years, preventive irradiation of areas of invasive interventions has been used as a method to prevent implantation metastasis. However, a number of randomized trials and recent meta-analysis have not demonstrated the benefits of this treatment approach. Due to the rarity of PM, the severe state of patients and tumor localization, the importance of radiation therapy in the palliative treatment of patients with pleural mesothelioma remains controversial. Recent completed and planned studies allow to commend the role of palliative radiation and recommend it in order to reduce pain.

Мезотелиома плевры (МП) остается заболеванием с плохим прогнозом, несмотря на использование последних достижений мультимодального лечения. Лучевая терапия (ЛТ) при МП традиционно используется в нескольких направлениях: в радикальном лечении как часть трехмодального подхода, для снижения риска метастазирования на грудной стенке в местах инвазивных вмешательств и в паллиативном лечении. Недостаток надежных рандомизированных исследований привел к отсутствию консенсуса относительно оптимальной радикальной стратегии лечения. Современные мировые рекомендации по лечению МП противоречивы в отношении использования адъювантной радиотерапии в мультимодальном лечении. Хотя роль ЛТ в лечении МП остается неясной, значительные успехи в ее планировании и проведении показывают, что длительная выживаемость может быть достигнута у тех пациентов, для которых до недавнего времени считалось целесообразным только паллиативное лечение. Профилактическое облучение зон инвазивных вмешательств много лет используется как способ профилактики имплантационного метастазирования. Однако ряд рандомизированных исследований и недавний метаанализ не продемонстрировали пользы от данного лечебного подхода. В связи с редкостью МП, тяжелым статусом пациентов, локализацией опухоли значение ЛТ в паллиативном лечении больных МП остается неоднозначным. Недавние завершенные и запланированные исследования позволяют положительно оценить роль паллиативного облучения и рекомендовать его с целью снижения болевого синдрома.

pleural mesotheliomaradiation therapyadjuvant radiotherapy in multimodal treatmentprophylactic irradiation of invasive intervention zonesмезотелиома плеврылучевая терапияадъювантная радиотерапия в мультимодальном лечениипрофилактическое облучение зон инвазивных вмешательствRobinson BW, Musk AW, Lake RA. Malignant mesothelioma. Lancet 2005; 366: 397–408.Robinson B. Malignant pleural mesothelioma: an epidemiological perspective. Ann Cardiothorac Surg 2012; 1: 491–6.Antman KH, Blum RH, Greenberger JS et al. Multimodality therapy for malignant mesothelioma based on a study of natural history. Am J Med 1980; 68: 356–2.Baas P, Fennell D, Kerr KM et al. Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26 (5): 31–9.Scherpereel A, Astoul P, Baas P et al. Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma. Eur Respir J 2010; 35 (3): 479–95.Woolhouse I, Bishop L, Darlison L et al. British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma. Thorax 2018; 73 (1): 1–30.Kindler HL, Ismaila N, Armato SG et al. Treatment of Malignant Pleural Mesothelioma: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2018; 36 (13): 1343–73.Barbieri PG, Marinaccio A, Ferrante P et al. Effects of combined therapies on the survival of pleural mesothelioma patients treated in Brescia, 1982–2006. Tumori 2012; 98 (2): 215–9.Mychalczak B, Nori D, Armstrong JG et al. Results of treatment of malignant pleural mesothelioma with surgery, brachytherapy and external beam irradiation. Endocurie Hypertherm Oncol 1989; 5: 245.Baldini EH, Recht A, Strauss GM et al. Patterns of failure after trimodality therapy for malignant pleural mesothelioma. Ann Thorac Surg 1997; 63 (2): 334–8.Allen AM, Den R, Wong JS et al. Influence of radiotherapy technique and dose on patterns of failure for mesothelioma patients after extrapleural pneumonectomy. Int J Radiat Oncol Biol Phys 2007; 68 (5): 1366–74.Krayenbuehl J, Oertel S, Davis JB, Ciernik IF. Combined photon and electron three-dimensional conformal versus intensity-modulated radiotherapy with integrated boost for adjuvant treatment of malignant pleural mesothelioma after pleuropneumonectomy. Int J Radiat Oncol Biol Phys 2007; 69 (5): 1593–9.Ahamad A, Stevens CW, Smythe WR et al. Promising early local control of malignant pleural mesothelioma following postoperative intensity modulated radiotherapy (IMRT) to the chest. Cancer J 2003; 9 (6): 476–84.Rice DC, Smythe WR, Liao Z et al. Dose-dependent pulmonary toxicity after postoperative intensity-modulated radiotherapy for malignant pleural mesothelioma. Int J Radiat Oncol Biol Phys 2007; 69 (2): 350–7.Allen AM, Czerminska M, Janne PA et al. Fatal pneumonitis associated with intensity-modulated radiation therapy for mesothelioma. Int J Radiat Oncol Biol Phys 2006; 65 (3): 640–5.Miles EF, Larrier NA, Kelsey CR et al. Intensity-modulated radiotherapy for resected mesothelioma: the Duke experience. Int J Radiat Oncol Biol Phys 2008; 71 (4): 1143–50.Krug LM, Pass HI, Rusch VW et al. Multicenter Phase II Trial of Neoadjuvant Pemetrexed Plus Cisplatin Followed by Extrapleural Pneumonectomy and Radiation for Malignant Pleural Mesothelioma. J Clin Oncol 2009; 27 (18): 3007–13.Van Schil PE, Baas P, Gaafar R et al. Trimodality therapy for malignant pleural mesothelioma: results from an EORTC phase II multicentre trial. Eur Respir J 2010; 36: 1362–9.Treasure T, Lang-Lazdunski L, Waller D et al. Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma: clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility study. Lancet Oncol 2011; 12 (8): 763–72.Federico R, Adolfo F, Giuseppe M et al. Phase II trial of neoadjuvant pemetrexed plus cisplatin followed by surgery and radiation in the treatment of pleural mesothelioma. BMC cancer 2013; 13: 22–9.Hasegawa S, Okada M, Tanaka F et al. Trimodality strategy for treating a feasibility study of induction pemetrexed plus cisplatin followed by extrapleural pneumonectomy and postoperative hemithoracic radiation (Japan Mesothelioma Interest Group 0601 Trial). Int J Clin Oncol 2016; 21 (3): 523–30.Lewis GD, Dalwadi SM, Farach A, Butler B. The Role of Adjuvant Radiotherapy in the Treatment of Pleural Mesothelioma. Ann Surg Oncol 2019; 26 (6): 1879–85.Nelson DB, Rice DC, Niu J et al. Long-Term Survival Outcomes of Cancer-Directed Surgery for Malignant Pleural Mesothelioma: Propensity Score Matching Analysis. J Clin Oncol 2017; 35 (29): 3354–62.Nelson DB, Rice DC, Mitchell KG, Tsao AS. Defining the role of adjuvant radiotherapy for malignant pleural mesothelioma: a propensity-matched landmark analysis of the National Cancer Database. J Thorac Dis 2019; 11 (4): 1269–78.Stahel RA, Riesterer O, Xyrafas A et al. Neoadjuvant chemotherapy and extrapleural pneumonectomy of malignant pleural mesothelioma with or without hemithoracic radiotherapy (SAKK 17/04): a randomised, international, multicentre phase 2 trial. Lancet Oncol 2015; 16 (16): 1651–8.Rimner A, Simone CB, Zauderer MG et al. Hemithoracic radiotherapy for mesothelioma: lack of benefit or lack of statistical power? Lancet Oncol. 2016; 17 (2): 43–4.Rosenzweig KE, Zauderer MG, Laser B et al. Pleural intensity-modulated radiotherapy for malignant pleural mesothelioma. Int J Radiat Oncol Biol Phys 2012; 83 (4): 1278–83.Rimner A, Spratt DE, Zauderer MG et al. Failure patterns after hemithoracic pleural intensity modulated radiation therapy for malignant pleural mesothelioma. Int J Radiat Oncol Biol Phys 2014; 90 (2): 394–401.Rimner A, Zauderer MG, Gomez DR et al. Phase II Study of Hemithoracic Intensity-Modulated Pleural Radiation Therapy (IMPRINT) As Part of Lung-Sparing Multimodality Therapy in Patients with Malignant Pleural Mesothelioma. J Clin Oncol 2016; 34 (23): 2761–8.Lee C, Bayman N, Swindell R et al. Prophylactic radiotherapy to intervention sites in mesothelioma: a systematic review and survey of UK practice. Lung Cancer 2009; 66: 150–6.Boutin C, Rey F, Viallat JR. Prevention of malignant seeding after invasive diagnostic procedures in patients with pleural mesothelioma. A randomized trial of local radiotherapy. Chest 1995; 108 (3): 754–8.Low EM, Khoury GG, Matthews AW et al. Prevention of tumour seeding following thoracoscopy in mesothelioma by prophylactic radiotherapy. Clin Oncol 1995; 7: 317–8.Cellerin L, Garry P, Mahe MA et al. Malignant pleural mesothelioma: Radiotherapy for the prevention of seeding nodules. Rev Mal Respir 2004; 21: 53–8.Bydder S, Phillips M, Joseph DJ et al. A randomised trial of single-dose radiotherapy to prevent procedure tract metastasis by malignant mesothelioma. Br J Cancer 2004; 91 (1): 9–10.O’Rourke N, Garcia JC, Paul J et al. A randomised controlled trial of intervention site radiotherapy in malignant pleural mesothelioma. Radiother Oncol 2007; 84: 18–22.Bayman N, Appel W, Ashcroft L et al. Prophylactic Irradiation of Tracts in Patients With Malignant Pleural Mesothelioma: An Open-Label, Multicenter, Phase III Randomized Trial. J Clin Oncol 2019; 37 (14): 1200–8.Clive AO, Taylor H, Dobson L et al. Prophylactic radiotherapy for the prevention of procedure-tract metastases after surgical and large-bore pleural procedures in malignant pleural mesothelioma (SMART): a multicentre, open-label, phase 3, randomised controlled trial. Lancet Oncol 2016; 17 (8): 1094–104.Muirhead R, O’Rourke N. Drain site radiotherapy in malignant pleural mesothelioma: a wasted resource. Eur Respir J 2007; 30: 1021.Bergamin S, Tio M, Stevens MJ. Prophylactic Procedure Tract Radiotherapy for Malignant Pleural Mesothelioma: A Systematic Review and Meta-Analysis. Clin Transl Radiat Oncol 2018; 13: 38–43.Bissett D, Macbeth FR, Cram I. The Role of Palliative Radiotherapy in Malignant Mesothelioma. Clin Oncol (R Coll Radiol) 1991; 3 (6): 315–7.Macleod N, Price A, O’Rourke N et al. Radiotherapy for the treatment of pain in malignant pleural mesothelioma: a systematic review. Lung Cancer 2014; 83 (2): 133–8.Macleod N, Chalmers A, O’Rourke N et al. Is radiotherapy useful for treating pain in mesothelioma? A phase II trial. J Thorac Oncol 2015; 10 (6): 944–50.Ashton M, O’Rourke N, Macleod N et al. SYSTEMS-2: a randomised phase II study of radiotherapy dose escalation for pain control in malignant pleural mesothelioma. Clin Transl Radiat Oncol 2018; 8: 45–9.MacRae RM, Ashton M, Lauk O et al. The role of radiation treatment in pleural mesothelioma: Highlights of the 14th International Conference of the International mesothelioma interest group. Lung Cancer 2019; 132: 24–7.