Return to intended oncologic treatment after surgery for malignant pleural mesothelioma

David B Nelson; David C Rice; Kyle G Mitchell; Anne S Tsao; Daniel R Gomez; Boris Sepesi; Reza J Mehran

doi:10.1016/j.jtcvs.2019.02.129

Return to intended oncologic treatment after surgery for malignant pleural mesothelioma

J Thorac Cardiovasc Surg. 2019 Sep;158(3):924-929. doi: 10.1016/j.jtcvs.2019.02.129. Epub 2019 Apr 16.

Authors

David B Nelson¹, David C Rice¹, Kyle G Mitchell¹, Anne S Tsao², Daniel R Gomez³, Boris Sepesi¹, Reza J Mehran⁴

Affiliations

¹ Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex.
² Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Tex.
³ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Tex.
⁴ Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex. Electronic address: rmehran@mdanderson.org.

PMID: 31430846
DOI: 10.1016/j.jtcvs.2019.02.129

Abstract

Objective: Trimodality therapy may prolong survival for patients with resectable malignant pleural mesothelioma. However, many patients are unable to complete therapy. We sought to identify risk factors for failing to complete adjuvant intensity-modulated radiation therapy after cytoreduction for malignant pleural mesothelioma.

Methods: We performed a single-institution review of those who received an extrapleural pneumonectomy or pleurectomy/decortication for malignant pleural mesothelioma from 2004 to 2017. Multivariable logistic regression was used to assess preoperative or intraoperative risk factors associated with failing to complete adjuvant intensity-modulated radiation therapy.

Results: A total of 160 patients were identified, among whom 94 (59%) received an extrapleural pneumonectomy and 66 (41%) received a pleurectomy/decortication. Adjuvant intensity-modulated radiation therapy was completed among 105 patients (66%). Reasons for failing to complete adjuvant intensity-modulated radiation therapy included mortality (19), dose constraints (21), postoperative morbidity or delayed recovery (11), and refused or unknown status (4). On multivariable analysis, American Society of Anesthesiologists 3+ classification (P = .002) and smoking history (P = .022) were associated with failure to complete adjuvant intensity-modulated radiation therapy, whereas forced expiratory volume in 1 second 70% or less of predicted and pStage 4 (T4) were significant on univariable analysis only. Other factors, including extrapleural pneumonectomy or pleurectomy/decortication, margin status, age, and histology, were not associated with receiving adjuvant intensity-modulated radiation therapy.

Conclusions: Many patients are unable to complete adjuvant intensity-modulated radiation therapy after cytoreduction. Failure to complete adjuvant intensity-modulated radiation therapy was associated with worse preoperative comorbidity, but not the type of surgery or margin status.

Keywords: IMRT; extrapleural pneumonectomy; intensity modulated radiation therapy; mesothelioma; pleurectomy decortication.

Publication types

Webcast

MeSH terms

Aged
Comorbidity
Cytoreduction Surgical Procedures* / adverse effects
Cytoreduction Surgical Procedures* / mortality
Databases, Factual
Female
Humans
Lung Neoplasms / mortality
Lung Neoplasms / therapy*
Male
Mesothelioma / mortality
Mesothelioma / therapy*
Mesothelioma, Malignant
Middle Aged
Pleural Neoplasms / mortality
Pleural Neoplasms / therapy*
Pneumonectomy* / adverse effects
Pneumonectomy* / mortality
Radiation Dosage
Radiotherapy, Adjuvant
Radiotherapy, Intensity-Modulated* / adverse effects
Radiotherapy, Intensity-Modulated* / mortality
Retrospective Studies
Risk Assessment
Risk Factors
Smoking / adverse effects
Treatment Outcome
Treatment Refusal*