Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX.
Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE.
Clin Lung Cancer. 2018 Sep;19(5):e685-e692. doi: 10.1016/j.cllc.2018.04.019. Epub 2018 May 5.
Although postoperative radiotherapy (RT) for malignant pleural mesothelioma (MPM) has historically been delivered using 3-dimensional conformal RT (3DCRT) techniques, multiple reports show noteworthy safety and efficacy of the more advanced intensity-modulated RT (IMRT). To our knowledge, this is the only known study to evaluate national practice patterns of IMRT utilization for MPM.
The National Cancer Data Base was queried for newly-diagnosed MPM patients who underwent definitive surgery (extrapleural pneumonectomy [EPP] or extended pleurectomy/decortication [P/D]) followed by adjuvant RT. Patients with metastatic disease, non-EPP or P/D surgical techniques, and lack of RT receipt (or without specified RT technique) were excluded. Statistics included multivariable logistic regression, Kaplan-Meier overall survival (OS) analysis, and Cox proportional hazards modeling.
Overall, 286 patients met criteria (181 [63%] IMRT and 105 [37%] 3DCRT). Temporal trends revealed that although 3DCRT was more common at initial time periods, IMRT utilization rose from 2004 to 2007 and stayed as a relatively constant majority thereafter. This was also present when substratifying the cohort according to EPP versus P/D approaches. IMRT was more often delivered at academic centers, along with institutions in the Southern United States, whereas 3DCRT was more frequently utilized in community facilities and in the Northeast (P ≤ .05 for all). RT technique did not affect OS (P > .05 for all comparisons).
In the United States, IMRT is now the most commonly utilized adjuvant RT technique for MPM. Facility and regional differences might associate with IMRT delivery. The findings of this investigation have implications for insurance coverage, clinical referral patterns, and ongoing and future prospective trial design.
尽管恶性胸膜间皮瘤（MPM）的术后放疗（RT）历史上一直采用三维适形放疗（3DCRT）技术，但多项报告表明，更先进的调强放疗（IMRT）具有显著的安全性和疗效。据我们所知，这是唯一一项评估 IMRT 用于 MPM 的国家实践模式的研究。
国家癌症数据库（National Cancer Data Base）对接受根治性手术（胸膜外全肺切除术[EPP]或广泛胸膜切除术/剥脱术[P/D]）后接受辅助 RT 的新诊断 MPM 患者进行了查询。排除患有转移性疾病、非 EPP 或 P/D 手术技术以及缺乏 RT 接受（或未指定 RT 技术）的患者。统计分析包括多变量逻辑回归、Kaplan-Meier 总生存（OS）分析和 Cox 比例风险建模。
共有 286 名患者符合标准（181 名[63%]接受 IMRT，105 名[37%]接受 3DCRT）。时间趋势显示，尽管 3DCRT 在最初的时间段更为常见，但 IMRT 的使用从 2004 年到 2007 年上升，并在此后保持相对稳定的多数。根据 EPP 与 P/D 方法对队列进行分层时也是如此。IMRT 更常在学术中心以及美国南部的机构中进行，而 3DCRT 则更常在社区设施和东北部进行（所有 P 值均<.05）。RT 技术对 OS 没有影响（所有比较的 P 值均>.05）。
在美国，IMRT 现在是 MPM 最常用的辅助 RT 技术。设施和区域差异可能与 IMRT 的应用有关。本研究的结果对保险覆盖范围、临床转诊模式以及正在进行和未来的前瞻性试验设计具有重要意义。
