• Kenneth E Rosenzweig.
• Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.. Electronic address: Kenneth.rosenzweig@mountsinai.org.
• Semin. Thorac. Cardiovasc. Surg. 2013 Jan 1; 25 (3): 245-50.

AbstractThe treatment of malignant pleural mesothelioma with radiation therapy has always been a technical challenge. Early experience with intensity-modulated radiation therapy demonstrated troubling toxicity. Recent reports from institutions have demonstrated that with greater experience, intensity-modulated radiation therapy can be delivered safely, both in the setting of pneumonectomy or pleurectomy. After pneumonectomy, the dose to the contralateral lung must be minimized, preferably with a volume of lung receiving 20 Gy (V20) to less than 5% and a mean lung dose of approximately 10%. In the setting of 2 intact lungs, the mean lung dose can be as high as 20 Gy. Expected rates of grade 3 or worse radiation pneumonitis are 12%-20%. The rates of fatal pneumonitis are approximately 3%-8% in these studies, which demonstrate the considerable toxicity of treatment, even with improved technique.© 2013 Published by Elsevier Inc.

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