Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex.
Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Tex.
J Thorac Cardiovasc Surg. 2019 Sep;158(3):924-929. doi: 10.1016/j.jtcvs.2019.02.129. Epub 2019 Apr 16.
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.
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.
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.
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.
三联疗法可能延长可切除恶性胸膜间皮瘤患者的生存时间。然而，许多患者无法完成治疗。我们试图确定在接受细胞减灭术后接受辅助调强放疗治疗恶性胸膜间皮瘤时无法完成治疗的风险因素。
我们对 2004 年至 2017 年间接受过胸膜外全肺切除术或胸膜切除术/剥脱术治疗恶性胸膜间皮瘤的患者进行了单机构回顾。多变量逻辑回归用于评估与无法完成辅助调强放疗相关的术前或术中危险因素。
共确定了 160 例患者，其中 94 例（59%）接受了胸膜外全肺切除术，66 例（41%）接受了胸膜切除术/剥脱术。105 例（66%）患者完成了辅助调强放疗。无法完成辅助调强放疗的原因包括死亡（19 例）、剂量限制（21 例）、术后并发症或恢复延迟（11 例）以及拒绝或未知状态（4 例）。多变量分析显示，美国麻醉医师协会 3+ 分类（P=0.002）和吸烟史（P=0.022）与无法完成辅助调强放疗相关，而 1 秒用力呼气量（FEV1）70%或更低和 p 期 4 期（T4）仅在单变量分析中具有显著意义。其他因素，包括胸膜外全肺切除术或胸膜切除术/剥脱术、切缘状态、年龄和组织学，与接受辅助调强放疗无关。
许多患者在细胞减灭术后无法完成辅助调强放疗。无法完成辅助调强放疗与术前合并症更差相关，但与手术类型或切缘状态无关。
