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JOURNAL ARTICLE

Single dose electron beam radiation therapy for tumor wound seeding prophylaxis in mesothelioma.

SOURCE: ASCO, 2004 Annual Meeting

T. C. Lo, J. Cassady, J. F. Beamis; Lahey Clinic Medical Center, Burlington, MA

Background: Wound seeding by tumor cells in the course of malignant disease is a well-documented phenomenon. Mesothelioma is one of the malignancies notoriously known to manifest symptomatic tumor seeding along tissue tracks from thoracoscopy, chest tube or needle drainage of pleural effusion, or needle or open pleural biopsy. Prognosis of this disease is grave and survival is usually short. However, when a patient develops gross seeding presenting with a symptomatic chest wall mass from malignant mesothelioma, the pain is typically excruciating. Unfortunately treatment options at that point in time are very limited and mostly ineffective. In an attempt to prevent the development of wound seeding after a diagnostic or therapeutic procedure in the management of mesothelioma, we piloted a treatment program by irradiating the site of the wound using single dose electron beam and the results are presented.

Methods: Eight patients with ages ranged form 52 to 80 years received chest wall irradiation to a total of 12 sites in an attempt to prevent wound seeding by tumor. All had a history of exposure to asbestos and a tissue diagnosis of mesothelioma. All patients received radiation therapy within 30 days after the procedure and all sites were treated with a 5-cm diameter cone. A single dose of 15 Gy using either 10 MeV or 12 MeV electron beam was delivered.

Results: All but one patient have died with a median follow-up of 4 moths (range 2 to 16 months). No patient developed wound seeding by tumor cells. There was no treatment related complication.

Conclusions: In this small series, it appears that prophylactic radiation therapy is effective in preventing wound seeding by tumor cells along tissue tracks in the management of mesothelioma. However, in view of the facts that mesothelioma is a rare tumor and the true incidence of wound seeding is unknown, a large-scale study on a multi-institutional level will be needed to assess the value of this unique treatment modality.