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. 2017 Jun;12(6):993-1000.
doi: 10.1016/j.jtho.2017.02.026. Epub 2017 Mar 21.

Improved Outcomes with Modern Lung-Sparing Trimodality Therapy in Patients with Malignant Pleural Mesothelioma

Fauzia Shaikh  1 , Marjorie G Zauderer  2 , Donata von Reibnitz  1 , Abraham J Wu  1 , Ellen D Yorke  3 , Amanda Foster  1 , Weiji Shi  4 , Zhigang Zhang  4 , Prasad S Adusumilli  5 , Kenneth E Rosenzweig  6 , Lee M Krug  2 , Valerie W Rusch  5 , Andreas Rimner  7
Affiliations

Improved Outcomes with Modern Lung-Sparing Trimodality Therapy in Patients with Malignant Pleural Mesothelioma

Fauzia Shaikh et al. J Thorac Oncol. 2017 Jun.

Abstract

Introduction: Higher target conformity and better sparing of organs at risk with modern radiotherapy (RT) may result in higher tumor control and less toxicity. In this study, we compare our institutional multimodality therapy experience of adjuvant chemotherapy and hemithoracic intensity-modulated pleural RT (IMPRINT) with previously used adjuvant conventional RT (CONV) in patients with malignant pleural mesothelioma (MPM) treated with lung-sparing pleurectomy/decortication (P/D).

Methods: We analyzed 209 patients who underwent P/D and adjuvant RT (131 who received CONV and 78 who received IMPRINT) for MPM between 1974 and 2015. The primary end point was overall survival (OS). The Kaplan-Meier method and Cox proportional hazards model were used to calculate OS; competing risks analysis was performed for local failure-free survival and progression-free survival. Univariate analysis and multivariate analysis were performed with relevant clinical and treatment factors.

Results: The median age was 64 years, and 80% of the patients were male. Patients receiving IMPRINT had significantly higher rates of the epithelial histological type, advanced pathological stage, and chemotherapy treatment. OS was significantly higher after IMPRINT (median 20.2 versus 12.3 months, p = 0.001). Higher Karnofsky performance score, epithelioid histological type, macroscopically complete resection, and use of chemotherapy/IMPRINT were found to be significant factors for longer OS in multivariate analysis. No significant predictive factors were identified for local failure or progression. Grade 2 or higher esophagitis developed in fewer patients after IMPRINT than after CONV (23% versus 47%).

Conclusions: Trimodality therapy including adjuvant hemithoracic IMPRINT, chemotherapy, and P/D is associated with promising OS rates and decreased toxicity in patients with MPM. Dose constraints should be applied vigilantly to minimize serious adverse events.

Keywords: Conventional RT; IMPRINT; Intensity-modulated pleural radiation therapy; Malignant pleural mesothelioma; Pleurectomy/decortication.

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Conflict of interest statement

Conflicts of Interest and Source of Funding: No relevant conflicts of interest were declared. This research was supported in part by an NIH Core Grant P30 CA008748

Figures

Figure 1
Figure 1. Kaplan-Meier Overall Survival Curves Stratified by RT technique
See this image and copyright information in PMC

Comment in

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