Addition of radiotherapy to surgery and chemotherapy improves survival in localized malignant pleural mesothelioma: A Surveillance, Epidemiology, and End Results (SEER) study
Autor: | Thomas J. Quinn, Inga S. Grills, Andrew B. Thompson, Zaid A. Siddiqui, Craig W. Stevens, Muayad F. Almahariq |
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Rok vydání: | 2020 |
Předmět: |
Male
Mesothelioma 0301 basic medicine Pulmonary and Respiratory Medicine Cancer Research medicine.medical_specialty Lung Neoplasms Multivariate analysis medicine.medical_treatment Disease law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Antineoplastic Combined Chemotherapy Protocols medicine Surveillance Epidemiology and End Results Humans Retrospective Studies Chemotherapy business.industry Mesothelioma Malignant medicine.disease Surgery Radiation therapy 030104 developmental biology Oncology Chemotherapy Adjuvant 030220 oncology & carcinogenesis Localized disease Female business |
Zdroj: | Lung Cancer. 146:120-126 |
ISSN: | 0169-5002 |
Popis: | Introduction Malignant pleural mesothelioma (MPM) is a devastating disease with poor survival outcomes for most patients. Optimizing therapeutic approaches is thus vital, but has been hampered by a dearth of randomized trials to guide decision making. We used a population-level database to evaluate the impact of radiotherapy as a component of trimodality therapy on overall survival (OS) in MPM. Methods We retrospectively reviewed the SEER Radiation/Chemotherapy database for patients with MPM who received surgery and chemotherapy, with or without radiotherapy. A propensity score-matched analysis with inverse probability of treatment weighting (IPTW) was performed. Weight-adjusted univariate KM analysis was performed and doubly robust, IPTW-adjusted multivariable cox proportional hazards regression modeling was also performed to quantify the effect of radiotherapy on OS in trimodality therapy for MPM. Results 1015 patients were identified. 678 patients received surgery and chemotherapy, and 337 patients received trimodality therapy. For patients with localized disease, OS was significantly improved with trimodality therapy (HR 0.56, CI 0.4 – 0.8, p = 0.001), which persisted with IPTW adjustment (HR 0.65, CI 0.49 – 0.95, p = 0.0248). No significant benefit was seen for patients with regional or distant disease. On multivariate analysis, positive predictors of survival after IPTW adjustment were female sex, diagnosis after 2005, and left-sided disease. Conclusions These findings support a significant benefit to OS by incorporating radiotherapy as a component of trimodality therapy for patients with localized MPM compared to only surgery and chemotherapy. It does not provide a significant overall survival benefit for patients with regional or metastatic disease. |
Databáze: | OpenAIRE |
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