PET-guided dose escalation tomotherapy in malignant pleural mesothelioma

Andrei Fodor, Claudio Fiorino, Italo Dell'Oca, Sara Broggi, Marcella Pasetti, Giovanni Mauro Cattaneo, Luigi Gianolli, Riccardo Calandrino, Nadia Gisella Di Muzio

Research output: Contribution to journalArticlepeer-review


Purpose: To test the feasibility of salvage radiotherapy using PET-guided helical tomotherapy in patients with progressive malignant pleural mesothelioma (MPM). Patients and Methods: A group of 12 consecutive MPM patients was treated with 56 Gy/25 fractions to the planning target volume (PTV); FDG-PET/CT simulation was always performed to include all positive lymph nodes and MPM infiltrations. Subsequently, a second group of 12 consecutive patients was treated with the same dose to the whole pleura adding a simultaneous integrated boost of 62.5 Gy to the FDG-PET/CT positive areas (BTV). Results: Good dosimetric results were obtained in both groups. No grade 3 (RTOG/EORTC) acute or late toxicities were reported in the first group, while 3 cases of grade 3 late pneumonitis were registered in the second group: the duration of symptoms was 2-10 weeks. Median overall survival was 8 months (1.2-50.5 months) and 20 months (4.3-33.8 months) from the beginning of radiotherapy, for groups I and II, respectively (p = 0.19). A significant impact on local relapse from radiotherapy was seen (median time to local relapse: 8 vs 17 months; 1-year local relapse-free rate: 16% vs 81%, p = 0.003). Conclusions: The results of this pilot study support the planning of a phase III study of combined sequential chemoradiotherapy with dose escalation to BTV in patients not able to undergo resection.

Original languageEnglish
Pages (from-to)736-743
Number of pages8
JournalStrahlentherapie und Onkologie
Issue number11
Publication statusPublished - Nov 2011


  • Helical tomotherapy
  • IGRT
  • Malignant pleural mesothelioma
  • PET imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Oncology


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