Prophylactic radiotherapy to intervention sites in mesothelioma: a systematic review and survey of UK practice.
AffiliationDepartment of Clinical Oncology, Christie Hospital NHS Trust, Wilmslow Road, Manchester M20 4BX, UK.
MetadataShow full item record
AbstractBACKGROUND AND PURPOSE: Patients with malignant pleural mesothelioma (MPM), who undergo chest instrumentation, may develop seeding at the site of intervention, leading to subcutaneous tumour. This is believed to be reduced by the common practice of prophylactic irradiation to intervention tracts (PIT). However, evidence to support PIT is currently inadequate and contentious. MATERIALS AND METHODS: We carried out a systematic search of published literature for articles relating to the incidence of chest wall intervention tract metastases and the use of PIT in mesothelioma. In addition, a survey of current practice was conducted in 54 UK oncology centres. RESULTS: Fourteen studies revealed an incidence of chest wall intervention tract metastases of 0-48% with a trend toward a higher rate of metastases for more invasive procedures. Three randomised controlled trials (RCTs), two prospective non-randomised studies and five retrospective series met the eligibility criteria to evaluate the role of PIT in MPM. Of the three RCTs, two did not support the use of PIT. None of the RCTs included patients who had received systemic chemotherapy. Of the oncology centres responding to the survey, 75% practiced PIT, and 80% would be interested in a trial to determine the efficacy of PIT. CONCLUSIONS: No consensus has been reached to support the use of PIT. However, most centres in the UK still offer PIT. There was widespread interest in a randomised controlled trial to establish PIT efficacy in the era of effective systemic chemotherapy for malignant pleural mesothelioma.
CitationProphylactic radiotherapy to intervention sites in mesothelioma: a systematic review and survey of UK practice. 2009, 66 (2):150-6 Lung Cancer
- Protocol for PIT: a phase III trial of prophylactic irradiation of tracts in patients with malignant pleural mesothelioma following invasive chest wall intervention.
- Authors: Bayman N, Ardron D, Ashcroft L, Baldwin DR, Booton R, Darlison L, Edwards JG, Lang-Lazdunski L, Lester JF, Peake M, Rintoul RC, Snee M, Taylor P, Lunt C, Faivre-Finn C
- Issue date: 2016 Jan 27
- Should all patients who have mesothelioma diagnosed by video-assisted thoracoscopic surgery have their intervention sites irradiated?
- Authors: Nagendran M, Pallis A, Patel K, Scarci M
- Issue date: 2011 Jul
- Protocol for the surgical and large bore procedures in malignant pleural mesothelioma and radiotherapy trial (SMART Trial): an RCT evaluating whether prophylactic radiotherapy reduces the incidence of procedure tract metastases.
- Authors: Clive AO, Wilson P, Taylor H, Morley AJ, de Winton E, Panakis N, Rahman N, Pepperell J, Howell T, Batchelor TJ, Jordan N, Lee YC, Dobson L, Maskell NA
- Issue date: 2015 Jan 9
- Prophylactic irradiation of intervention sites in malignant pleural mesothelioma.
- Authors: Froment MA, Fréchette E, Dagnault A
- Issue date: 2011 Nov
- Prophylactic radiotherapy for the prevention of procedure-tract metastases after surgical and large-bore pleural procedures in malignant pleural mesothelioma (SMART): a multicentre, open-label, phase 3, randomised controlled trial.
- Authors: Clive AO, Taylor H, Dobson L, Wilson P, de Winton E, Panakis N, Pepperell J, Howell T, Stewart SA, Penz E, Jordan N, Morley AJ, Zahan-Evans N, Smith S, Batchelor TJP, Marchbank A, Bishop L, Ionescu AA, Bayne M, Cooper S, Kerry A, Jenkins P, Toy E, Vigneswaran V, Gildersleve J, Ahmed M, McDonald F, Button M, Lewanski C, Comins C, Dakshinamoorthy M, Lee YCG, Rahman NM, Maskell NA
- Issue date: 2016 Aug