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



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.



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%).



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.
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
Fauzia
F
Shaikh
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
Marjorie G
MG
Zauderer
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
Donata
D
von Reibnitz
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
Abraham J
AJ
Wu
Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York.
Ellen D
ED
Yorke
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
Amanda
A
Foster
Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
Weiji
W
Shi
Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
Zhigang
Z
Zhang
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Prasad S
PS
Adusumilli
Department of Radiation Oncology, Mount Sinai Medical Center, New York, New York.
Kenneth E
KE
Rosenzweig
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
Lee M
LM
Krug
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Valerie W
VW
Rusch
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: rimnera@mskcc.org.
Andreas
A
Rimner
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D008654:Mesothelioma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000401:mortality*; D010997:Pleural Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011013:Pneumonectomy / Q000401:mortality*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D050397:Radiotherapy, Intensity-Modulated / Q000401:mortality*; D015996:Survival Rate; D019616:Thoracic Surgical Procedures
Conventional RT; IMPRINT; Intensity-modulated pleural radiation therapy; Malignant pleural mesothelioma; Pleurectomy/decortication