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The Role of Adjuvant Radiotherapy in the Treatment of Pleural Mesothelioma

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

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.

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Acknowledgments

John H. Lee Foundation.

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Authors and Affiliations

  1. Department of Radiation Oncology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA

    Gary D. Lewis MD

  2. Department of Radiation Oncology, Houston Methodist Hospital, Cancer Center and Research Institute, Weil Cornell Medical College, Houston, TX, 77030, USA

    Gary D. Lewis MD, Andrew Farach MD, E. Brian Butler MD & Bin S. Teh MD

  3. Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, USA

    Shraddha M. Dalwadi MD

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  1. Gary D. Lewis MD
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Correspondence to Bin S. Teh MD.

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Gary D. Lewis, Shraddha M. Dalwadi, Andrew Farach, E. Brian Butler, and Bin S. Teh declare that no conflicts of interest exist.

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Lewis, G.D., Dalwadi, S.M., Farach, A. et al. The Role of Adjuvant Radiotherapy in the Treatment of Pleural Mesothelioma. Ann Surg Oncol 26, 1879–1885 (2019). https://doi.org/10.1245/s10434-019-07235-9

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  • DOI: https://doi.org/10.1245/s10434-019-07235-9

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