Background
Retrospective dosimetric/clinical technique report. N=35 MPM patients treated with EPP → hemithoracic RT at Memorial Sloan-Kettering 1990–2001. Describes the 3D conformal RT (3D-CRT) photon/electron technique with customized blocking underlying the Rusch (2001) phase 2 series.
Interventions and follow up
Treatment: 3D conformal hemithoracic RT (combined photon/electron fields, customized blocking) after EPP; median 54 Gy
Primary endpoint: Dosimetric coverage and normal tissue sparing
mFollow up: Not applicable (technique description)
Primary endpoint: Dosimetric coverage and normal tissue sparing
mFollow up: Not applicable (technique description)
Results
Median dose: 54 Gy (range 45–54 Gy)
Critical structure dose distributions: Adequate tumor coverage while limiting heart, spinal cord, liver, stomach, and contralateral lung doses
Critical structure dose distributions: Adequate tumor coverage while limiting heart, spinal cord, liver, stomach, and contralateral lung doses
Adverse events
Most common: RTOG grade 1–2 nausea/vomiting, lung, esophageal, and skin toxicities; well tolerated
Severe: No grade 3–4 toxicities reported in this technique description
Other: 3D-CRT with blocking allowed adequate hemithoracic coverage without prohibitive normal tissue doses
Severe: No grade 3–4 toxicities reported in this technique description
Other: 3D-CRT with blocking allowed adequate hemithoracic coverage without prohibitive normal tissue doses
Conclusions
Hemithoracic 3D-CRT delivering 54 Gy after EPP is technically feasible with acceptable toxicity. The combined photon/electron technique with customized blocking achieves adequate target coverage while limiting critical structure doses, underpinning the MSKCC approach and the Rusch phase 2 results.
Key Limitations
Technique/dosimetric report, not an outcomes trial; small retrospective N; complex photon/electron technique operator-dependent and largely superseded by IMRT.
Clinical Context
Documented the 3D-CRT technique behind the Rusch 54 Gy regimen; subsequently replaced by hemithoracic IMRT for improved conformality and OAR sparing.