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11-03-2017 | Mesothelioma | Article

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

Journal:
Journal of Radiation Oncology

Authors: Nisha Ohri, Emanuela Taioli, Bian Liu, Andrea Wolf, Jorge Gomez, Raja Flores, Kenneth E. Rosenzweig

Publisher: Springer Berlin Heidelberg

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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