Extra-pleural pneumonectomy in the era of image-guided intensity-modulated radiotherapy

Marco Trovo, Davide Franceschini, Carlo Furlan, Francesca Pietrobon, Stefano Vagge, Eleonora Farina, Alberto Revelant, Luca Visani, Virginia Maragna, Giuseppe Parisi, Vieri Scotti

Research output: Contribution to journalArticlepeer-review


Purpose: To assess the outcome of malignant pleural mesothelioma patients treated with extra-pleural pneumonectomy (EPP) and adjuvant radiotherapy (RT), using the most advanced radiotherapeutic techniques, namely image-guided intensity-modulated RT (IG-IMRT). Methods and materials: Fifty-four patients were analyzed. Minimum radiation dose was 50 Gy (2 Gy/fr). Planning target volume encompassed the entire hemithorax, including the ipsilateral mediastinum if interested by disease, the pericardium and diaphragm, and any drain sites. The study endpoints included loco-regional control (LRC), distant metastases free survival (DMFS), and overall survival (OS), as well as radiation-related toxicity. Results: Major patients and treatment characteristics were the following: median age 62 years, epithelioid histology in 51 (94%) cases, locally advanced disease in 41 (90%) cases, and metastatic mediastinal lymph nodes in 27 patients (50%). Only 7 patients (13%) had gross residual disease after surgery. Chemotherapy was administered in 38 patients (70%). Median follow-up was 16 months (range 0–73 months). Median and 2-year OS were 21 months and was 43.8%, respectively. The predominant pattern of failure was distant: 34 patients (62.9%) developed some component of distant failure, and only 5 patients (9.2%) developed an isolated loco-regional recurrence. The estimates of LRC and DMFS at 2 years were 63.4% and 43.4%, respectively. Three fatal pneumonitis were documented. Other major toxicities included: Grade 2 and 3 pneumonitis in 1 and 2 cases, respectively, 1 case of bronchial fistula, pleural empyema, and Grade 3 esophagitis, respectively. Conclusions: Although executed in the era of high-technology radiotherapy (IG-IMRT), EPP should not be routinely performed.

Original languageEnglish
Pages (from-to)854-859
Number of pages6
JournalRadiologia Medica
Issue number9
Publication statusPublished - Sept 1 2019


  • Extra-pleural pneumonectomy
  • Image-guided IMRT
  • Malignant pleural mesothelioma

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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