Considerations for post-operative radiotherapy to the hemithorax following extrapleural pneumonectomy in malignant pleural mesothelioma

With growing interest in evaluating extrapleural pneumonectomy (EPP) and post-operative in selected patients with early stage malignant pleural mesothelioma, it is essential that clinical trials should be conducted using a clear and reproducible radiotherapy protocol. The considerations which have determined the policy of radiotherapy planning and treatment delivery for patients with mesothelioma in The Netherlands are given. As well as general considerations such as patient selection, target volume and critical organ delineation, a dose-fractionation scheme, constraints relating to normal tissue, treatment planning, the type of external beam equipment, treatment verification and radiation toxicity and scoring are all taken into account.