Diseases of the pleura: Edited by Richard W. LightProphylactic radiotherapy for pleural puncture sites in mesothelioma: the controversy continuesDavies, Helen Ea; Musk, Arthur Wb; Lee, YC Garyc,dAuthor Information aOxford Centre for Respiratory Medicine, Oxford, UK bUniversity of Western Australia, Perth, Australia cOxford Centre for Respiratory Medicine and University of Oxford, Oxford, UK dCentre for Respiratory Research, University College London, London, UK Correspondence to Y.C. Gary Lee, Consultant and Senior Lecturer, Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, OX3 7LJ, UK Tel: +44 1865 225230; fax: +44 1865 225221; e-mail: [email protected] Current Opinion in Pulmonary Medicine: July 2008 - Volume 14 - Issue 4 - p 326-330 doi: 10.1097/MCP.0b013e3282fcea50 Buy Metrics Abstract Purpose of review Malignant mesothelioma is a uniformly fatal disease and active supportive care, minimizing patient morbidity, remains the accepted standard treatment. Tract metastases in patients with mesothelioma are a well recognized complication of pleural intervention and prophylactic radiotherapy is commonly implemented to prevent their occurrence. This review critically analyzes the published literature to establish the role of prophylactic radiotherapy to pleural puncture sites and highlights controversies that exist. Recent findings Current practice is based on a clinical study published in 1995. However, two recent randomized controlled trials did not support the widely held belief that all patients undergoing diagnostic or therapeutic pleural puncture should receive prophylactic drain site irradiation. Data assessing the incidence of associated morbidity from tract metastases suggest that rates are lower than previously thought. Summary The routine administration of radiotherapy in all patients with mesothelioma following pleural intervention remains debated. Instead of prophylactic irradiation, directing surveillance toward patients with large (e.g. thoracoscopic) pleural puncture sites and reserving treatments to symptomatic deposits may be more appropriate. This strategy would optimize patient care and minimize hospital visits, but allow prompt instigation of treatment if symptoms develop. © 2008 Lippincott Williams & Wilkins, Inc.