Lancet Oncol: Treatment of malignant thoracic mesothelioma with radiotherapy followed by a full pulmonary excision of the thoracic membrane

A new treatment for malignant thoracic mesothelioma, known as post-radiation mesothelioma surgery (SMART), a short-term accelerated course of treatment (IMRT) with a large dose of semi-open chest-tone radiotherapy, followed by a full lung excision outside the thoracic membrane.
the purpose of this study is to assess the clinical feasibility of smart solutions.
the study was a single-center, Phase 2 trial that recruited patients aged 18 or older with ECOG performance status of 0-2, histologically proven, previously untreated, removable cT1-3N0M0 stage malignant thoracic mesothelioma.
patients were treated with 25Gy in the same half chest cavity for 1 week, 5 times a day, while 5Gy was treated in high-risk areas, followed by a full pulmonary excision of the thoracic thoracic membrane within 1 week.
patients with ypN-plus were given complementary chemotherapy during the final pathological examination.
end point is feasibility, defined as the number of patients with peri-surgical treatment-related deaths (level 5 events) or morbidity (level 3 or 4 events).
key secondary endpoint is the cumulative occurrence of relapses in the distance.
November 1, 2008 - October 31, 2019, 102 patients were recruited and 96 eligible patients received SMART treatment as planned for inclusion in the final analysis.
surgery was performed in the median 5 days (range 2-12 days) after completion of IMRT.
47 patients (49%) had a 3-4 level event within 30 days of the peri-surgery period, and 1 patient (1%) died within 30 days of the peri-surgery period (level 5 event; pneumonia).
46.8 months (IQR 13.4 to 61.2) and a cumulative long-distance recurrence rate of 62 cases (63.3% (95% CI 52.3 to 74.4) over a five-year period.
most common first relapse site was the side chest (33 out of 72 patients ) and the abdominal cavity (32 cases ( 44 per cent) .
results show that for patients with malignant thoracic mesothelioma, post-thoracic full pulmonary excision can achieve good near-term and long-term results.
, however, it is necessary to reduce the level 4 adverse events in the programme, which may be technically demanding;