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24.02.2019 | Thoracic Oncology | Ausgabe 6/2019

Annals of Surgical Oncology 6/2019

The Role of Adjuvant Radiotherapy in the Treatment of Pleural Mesothelioma

Annals of Surgical Oncology > Ausgabe 6/2019
MD Gary D. Lewis, MD Shraddha M. Dalwadi, MD Andrew Farach, MD E. Brian Butler, MD Bin S. Teh
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1245/​s10434-019-07235-9) contains supplementary material, which is available to authorized users.
This work was presented in part as an abstract at the American Radium Society (ARS) 100th Annual Meeting, Orlando, FL, USA, 5–8 May 2018.

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Pleural mesothelioma is a rare but aggressive form of cancer. Local recurrence represents the majority of treatment failures and overall survival (OS) outcomes remain dismal. Adding locoregional treatment with radiotherapy after surgical resection has been considered but its role remains uncertain.


The purpose of this study was to evaluate the outcomes of adjuvant radiation therapy (RT) for patients with malignant pleural mesothelioma.


The National Cancer Data Base (NCDB) was queried (2004–2013) for patients with malignant mesothelioma. Patients were divided into three groups: observation, surgery alone, and surgery followed by adjuvant RT. Statistics included Fisher’s exact or Chi square tests to analyze categorical proportions between groups, Kaplan–Meier analysis to evaluate OS, and Cox proportional hazards modeling to determine variables associated with OS. Propensity matching was performed to make comparisons between homogenous groups.


Overall, the surgery plus radiotherapy group had a higher median survival (21.4 months) compared with surgery alone (16.59 months) [p < 0.001]. RT was more likely to be delivered after extrapleural pneumonectomy than with lung-sparing surgical approaches. On multivariable analysis, receipt of surgery plus radiotherapy, chemotherapy administration, and higher socioeconomic status were associated with improved OS (p < 0.0001). After propensity matching, receipt of surgery plus radiotherapy and chemotherapy administration were still associated with improved OS (p < 0.05).


In the treatment of malignant pleural mesothelioma, adjuvant radiotherapy after surgical intervention was associated with improved OS. This study is the largest study of adjuvant radiotherapy to date, and our findings highlight the need for additional prospective data.

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