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Radiation therapy for localized malignant pleural mesothelioma: a propensity score-matched analysis of the National Cancer Data Base

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

The objectives of this study were to analyze rates of radiation therapy (RT) utilization for malignant pleural mesothelioma (MPM) and evaluate the association between RT and overall survival (OS).

Methods

The National Cancer Data Base (NCDB) was queried to identify patients with non-metastatic MPM diagnosed between 2004 and 2013. RT was defined as receipt of 40-65Gy of external beam radiation therapy to the chest wall, lungs, or pleura. Multivariable logistic regression was performed to identify predictors of RT receipt. OS was estimated using the Kaplan-Meier method. Propensity score matching was performed to verify the effect of RT on OS.

Results

Among 14,090 MPM patients, 3.6% received RT. Younger age, lower co-morbidity score, private insurance, surgical resection, and receipt of chemotherapy were associated with increased RT utilization. Patients who received RT had higher crude 2 and 5-year OS rates (33.9 and 12.6%, respectively) compared to patients who did not (19.5 and 5.3%, respectively; p < 0.001). In multivariable analysis and propensity matched analysis, definitive RT was significantly associated with improved survival (adjusted hazard ratio [adj HR] 0.78, 95% CI 0.70–0.87) and (adj HR 0.77, 95% CI 0.67–0.89), respectively. Compared to no therapy, surgery and RT (adj HR 0.41, 95% CI 0.31–0.54) and trimodality therapy (adj HR 0.47, 95% CI 0.40–0.55) were associated with the best survival.

Conclusions

The rate of RT utilization for non-metastatic MPM has remained low over the past decade. Patients who received RT had improved OS. Combined modality therapy was associated with a greater improvement in survival than single modality treatment.

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References

  1. Vogelzang NJ, Rusthoven JJ, Symanowski J et al (2003) Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol 21:2636–2644

    Article  CAS  PubMed  Google Scholar 

  2. Zalcman G, Mazieres J, Margery J, et al: Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial. Lancet, 2015

  3. Taioli E, Wolf AS, Flores RM (2015a) Meta-analysis of survival after pleurectomy decortication versus extrapleural pneumonectomy in mesothelioma. Ann Thorac Surg 99:472–480

    Article  PubMed  Google Scholar 

  4. Rusch VW, Rosenzweig K, Venkatraman E et al (2001) A phase II trial of surgical resection and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma. J Thorac Cardiovasc Surg 122:788–795

    Article  CAS  PubMed  Google Scholar 

  5. Krug LM, Pass HI, Rusch VW et al (2009) Multicenter phase II trial of neoadjuvant pemetrexed plus cisplatin followed by extrapleural pneumonectomy and radiation for malignant pleural mesothelioma. J Clin Oncol 27:3007–3013

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Stahel RA, Riesterer O, Xyrafas A et al (2015) Neoadjuvant chemotherapy and extrapleural pneumonectomy of malignant pleural mesothelioma with or without hemithoracic radiotherapy (SAKK 17/04): a randomised, international, multicentre phase 2 trial. Lancet Oncol 16:1651–1658

    Article  PubMed  Google Scholar 

  7. Rimner A, Zauderer MG, Gomez DR, et al (2016a) Phase II study of hemithoracic intensity-modulated pleural radiation therapy (IMPRINT) as part of lung-sparing multimodality therapy in patients with malignant pleural mesothelioma. J Clin Oncol

  8. Rimner A, Simone CB 2nd, Zauderer MG et al (2016b) Hemithoracic radiotherapy for mesothelioma: lack of benefit or lack of statistical power? Lancet Oncol 17:e43–e44

    Article  PubMed  Google Scholar 

  9. Steele GD Jr, Winchester DP, Menck HR (1994) The National Cancer Data Base. A mechanism for assessment of patient care Cancer 73:499–504

    PubMed  Google Scholar 

  10. Taioli E, Wolf AS, Camacho-Rivera M et al (2015b) Determinants of survival in malignant pleural mesothelioma: a surveillance, epidemiology, and end results (SEER) study of 14,228 patients. PLoS One 10:e0145039

    Article  PubMed  PubMed Central  Google Scholar 

  11. Batirel HF, Metintas M, Caglar HB et al (2008) Trimodality treatment of malignant pleural mesothelioma. J Thorac Oncol 3:499–504

    Article  PubMed  Google Scholar 

  12. Flores RM, Krug LM, Rosenzweig KE et al (2006) Induction chemotherapy, extrapleural pneumonectomy, and postoperative high-dose radiotherapy for locally advanced malignant pleural mesothelioma: a phase II trial. J Thorac Oncol 1:289–295

    Article  PubMed  Google Scholar 

  13. Yajnik S, Rosenzweig KE, Mychalczak B et al (2003) Hemithoracic radiation after extrapleural pneumonectomy for malignant pleural mesothelioma. Int J Radiat Oncol Biol Phys 56:1319–1326

    Article  PubMed  Google Scholar 

  14. Gupta V, Mychalczak B, Krug L et al (2005) Hemithoracic radiation therapy after pleurectomy/decortication for malignant pleural mesothelioma. Int J Radiat Oncol Biol Phys 63:1045–1052

    Article  PubMed  Google Scholar 

  15. Miles EF, Larrier NA, Kelsey CR et al (2008) Intensity-modulated radiotherapy for resected mesothelioma: the Duke experience. Int J Radiat Oncol Biol Phys 71:1143–1150

    Article  PubMed  Google Scholar 

  16. Rice DC, Smythe WR, Liao Z et al (2007) Dose-dependent pulmonary toxicity after postoperative intensity-modulated radiotherapy for malignant pleural mesothelioma. Int J Radiat Oncol Biol Phys 69:350–357

    Article  PubMed  Google Scholar 

  17. Allen AM, Czerminska M, Janne PA et al (2006) Fatal pneumonitis associated with intensity-modulated radiation therapy for mesothelioma. Int J Radiat Oncol Biol Phys 65:640–645

    Article  PubMed  Google Scholar 

  18. Patel PR, Yoo S, Broadwater G et al (2012) Effect of increasing experience on dosimetric and clinical outcomes in the management of malignant pleural mesothelioma with intensity-modulated radiation therapy. Int J Radiat Oncol Biol Phys 83:362–368

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Nisha Ohri & Kenneth E. Rosenzweig

  2. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Emanuela Taioli & Bian Liu

  3. Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Emanuela Taioli & Bian Liu

  4. Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Emanuela Taioli, Andrea Wolf & Raja Flores

  5. Department of Hematology Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Jorge Gomez

Authors
  1. Nisha Ohri
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  2. Emanuela Taioli
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  3. Bian Liu
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  4. Andrea Wolf
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  5. Jorge Gomez
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  6. Raja Flores
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  7. Kenneth E. Rosenzweig
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Corresponding author

Correspondence to Kenneth E. Rosenzweig.

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No funding was received for this study.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Statement of informed consent was not applicable since the manuscript does not contain any patient data.

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Ohri, N., Taioli, E., Liu, B. et al. Radiation therapy for localized malignant pleural mesothelioma: a propensity score-matched analysis of the National Cancer Data Base. J Radiat Oncol 6, 265–272 (2017). https://doi.org/10.1007/s13566-017-0299-2

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  • DOI: https://doi.org/10.1007/s13566-017-0299-2

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