The Role of Adjuvant Radiotherapy in the Treatment of Pleural Mesothelioma

Journal Article · Sat Jun 15 04:00:00 EDT 2019 · Annals of Surgical Oncology (Online)

DOI:https://doi.org/10.1245/S10434-019-07235-9· OSTI ID:22927749

Lewis, Gary D. ^[1]; Dalwadi, Shraddha M. ^[2]; Farach, Andrew; Brian Butler, E.

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1. The University of Texas Medical Branch at Galveston, Department of Radiation Oncology (United States)
2. Baylor College of Medicine, Department of Radiation Oncology (United States)

Background: Pleural mesothelioma is a rare but aggressive form of cancer. Local recurrence represents the majority of treatment failures and overall survival (OS) outcomes remain dismal. Adding locoregional treatment with radiotherapy after surgical resection has been considered but its role remains uncertain. Objective: The purpose of this study was to evaluate the outcomes of adjuvant radiation therapy (RT) for patients with malignant pleural mesothelioma. Methods: The National Cancer Data Base (NCDB) was queried (2004–2013) for patients with malignant mesothelioma. Patients were divided into three groups: observation, surgery alone, and surgery followed by adjuvant RT. Statistics included Fisher’s exact or Chi square tests to analyze categorical proportions between groups, Kaplan–Meier analysis to evaluate OS, and Cox proportional hazards modeling to determine variables associated with OS. Propensity matching was performed to make comparisons between homogenous groups. Results: Overall, the surgery plus radiotherapy group had a higher median survival (21.4 months) compared with surgery alone (16.59 months) [p < 0.001]. RT was more likely to be delivered after extrapleural pneumonectomy than with lung-sparing surgical approaches. On multivariable analysis, receipt of surgery plus radiotherapy, chemotherapy administration, and higher socioeconomic status were associated with improved OS (p < 0.0001). After propensity matching, receipt of surgery plus radiotherapy and chemotherapy administration were still associated with improved OS (p < 0.05). Conclusions: In the treatment of malignant pleural mesothelioma, adjuvant radiotherapy after surgical intervention was associated with improved OS. This study is the largest study of adjuvant radiotherapy to date, and our findings highlight the need for additional prospective data.

• OSTI ID: 22927749
• Journal Information: Annals of Surgical Oncology (Online), Journal Name: Annals of Surgical Oncology (Online) Journal Issue: 6 Vol. 26; ISSN 1534-4681
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CHEMOTHERAPY
LUNGS
NEOPLASMS
PATIENTS
RADIOTHERAPY
SURGERY