Patterns of Failure, Toxicity, and Survival after Extrapleural Pneumonectomy and Hemithoracic Intensity-Modulated Radiation Therapy for Malignant Pleural.

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Patterns of Failure, Toxicity, and Survival after Extrapleural Pneumonectomy and Hemithoracic Intensity-Modulated Radiation Therapy for Malignant Pleural Mesothelioma Daniel R. Gomez, MD, David S. Hong, MD, Pamela K. Allen, PhD, James S. Welsh, MD, Reza J. Mehran, MD, Anne S. Tsao, MD, Zhongxing Liao, MD, Stephen D. Bilton, CMD, Ritsuko Komaki, MD, David C. Rice, MD Journal of Thoracic Oncology Volume 8, Issue 2, Pages 238-245 (February 2013) DOI: 10.1097/JTO.0b013e31827740f0 Copyright © 2013 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Kaplan–Meier survival curves for patients treated with extrapleural pneumonectomy followed by intensity-modulated radiation therapy for malignant pleural mesothelioma. A, Locoregional–progression-free survival; (B), distant metastasis–free survival; (C), overall survival. Journal of Thoracic Oncology 2013 8, 238-245DOI: (10.1097/JTO.0b013e31827740f0) Copyright © 2013 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Fused PET or CT scans and radiation isodose curves (left) and diagnostic PET scans (right) of treatment failures in two different patients after extrapleural pneumonectomy followed by intensity-modulated radiation therapy for malignant pleural mesothelioma. A, Arrows indicate failure within a cold spot where the isodose lines curved inward along the chest wall and thus compromised target coverage in this portion of the radiation field. B, Recurrence in high-dose region and within subcutaneous tissues adjacent to the surgical scar. CT, computed tomography; PET, positron emission tomography. Journal of Thoracic Oncology 2013 8, 238-245DOI: (10.1097/JTO.0b013e31827740f0) Copyright © 2013 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 Comparison of EPP alone with EPP + IMRT with regards to, (A), overall survival, and (B), disease-free survival. EPP, extrapleural pneumonectomy; IMRT, intensity-modulated radiation therapy. Journal of Thoracic Oncology 2013 8, 238-245DOI: (10.1097/JTO.0b013e31827740f0) Copyright © 2013 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 Kaplan–Meier curves illustrating (A), distant metastasis and (B), overall survival according to nodal status and histologic subtype in patients treated with extrapleural pneumonectomy plus intensity-modulated radiation therapy. Journal of Thoracic Oncology 2013 8, 238-245DOI: (10.1097/JTO.0b013e31827740f0) Copyright © 2013 International Association for the Study of Lung Cancer Terms and Conditions