The Impact of Adjuvant Hemithoracic Radiation on Outcomes in Patients With Stage I-III Malignant Pleural Mesothelioma

Background: The outcomes associated with receipt of adjuvant radiation in patients after surgery for MPM are poorly understood. Objective: The objective of this study was to use 2 registries to compare the outcomes of patients receiving adjuvant radiation or no radiation after definitive surgery for pathologic stage I–III MPM. Methods: Patients with resected pathologic stage I–III MPM were identified from the Duke University registry (1996–2016) and National Cancer Database (NCDB) (2004–2015). The primary outcome was overall survival. Propensity score-matched and landmark subgroup analyses were performed. Results: A total of 212 institutional and 1615 NCDB patients met criteria. In both cohorts, patients who underwent radiation were more likely to have margin-negative resection and more advanced pathologic stage. At a landmark time of 4.4 and 4.7 months from surgery, Duke [hazard ratio (HR) 1.14; 95% confidence interval (CI) 0.62–2.11] and NCDB patients (HR 0.97; 95% CI 0.81–1.17) who received adjuvant radiation did not experience improved survival compared to those who did not receive radiation in multivariable analysis. Duke patients who received radiation had similar incidence of recurrence and time to both overall recurrence and ipsilateral recurrence (HR 0.87; 95% CI 0.43–1.77) compared to those who did not. Duke patients experienced 100 grade 1/2, 21 grade 3/4, and one grade 5 toxicity events during radiation. Conclusions: In this dual registry analysis of patients with resected stage I–III MPM, the receipt of adjuvant hemithoracic radiation was not associated with improved survival compared to no radiation.