How do you approach medically inoperable pleural mesothelioma confined to a single hemithorax and symptomatic for chest wall pain, not responsive to first-line systemic therapy?

E.g. right hemithorax disease from lung apex to diaphragm, no response s/p 3 cycles of cis/pem.

Answer from: Radiation Oncologist at Academic Institution

In these settings, our convention has been to use 20 Gy in 5 fractions. This is based on studies that have shown palliative benefit in mesothelioma with doses at or exceeding 4 Gy per fraction, and also following the phase 2 SYSTEMS trial (MacLeod JTO 2015) using the 20 Gy in 5 fraction regimen. In ...

Answer from: Radiation Oncologist at Community Practice

I would consider dose escalation if possible, extrapolating from post op data. 45/15 or 50/25 with SIB to 60 as per this recent RCT, if the patient has a good PS.Trovo et al., PMID 33259933

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Radiation Oncologist at Cancer Care Centers of Brevard
Could also consider adding tumor treating fields/O...

Answer from: Medical Oncologist at Community Practice

In addition to radiation option, immunotherapy can be tried as well.

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How do you approach medically inoperable pleural mesothelioma confined to a single hemithorax and symptomatic for chest wall pain, not responsive to first-line systemic therapy?

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