Author of

• 18606

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  P3.03 - Poster Session with Presenters Present (ID 473)

  • Event: WCLC 2016
  • Type: Poster Presenters Present
  • Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
  • Presentations: 1
  • Moderators:
  • Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)

  • 18637

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    P3.03-031 - Definitive Radiation Therapy is Associated with Improved Survival in Non-Metastatic Malignant Pleural Mesothelioma (ID 4458)

    14:30 - 14:30  |  Author(s): A. Wolf
    • Abstract

    Background:
    To analyze rates of definitive 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. Definitive RT was defined as receipt of 40-65 Gy of external beam radiation therapy to the chest wall, lungs, or pleura. Multivariate logistic regression was performed to identify predictors of RT receipt. OS was estimated using the Kaplan-Meier method. Cox proportional hazards models were used to identify predictors of mortality. Propensity score matching was performed to verify the effect of definitive 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). On multivariable analysis and propensity matched analysis, definitive RT was 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.

    Comparison of Overall Survival According to Definitive RT

    	2-yr rate	95% CI	5-yr rate	95% CI	p	Adjusted HR	95% CI
    No RT	19.5%	18.8-20.3	5.3%	4.9-5.8	<0.001	1.00	Ref
    RT	33.9%	29.4-38.4	12.6%	9.4-16.3	<0.001	0.78	0.70-0.87

    
    
    Conclusion:
    The rate of definitive RT utilization for non-metastatic MPM has remained low over the past decade. Patients who received RT had improved OS, suggesting a role for increased utilization, particularly with the advancement in RT techniques. Combined modality therapy was associated with a greater improvement in survival than any single modality treatment.