Survival benefit after radiotherapy for patients with malignant pleural mesothelioma: A propensity score-matched study

Our plain-English summary of Survival benefit after radiotherapy for patients with malignant pleural mesothelioma: A propensity score-matched study, by L. Lian, H. Lei, S. Cheng, et al (MedComm, 2023).

The study

• Authors: L. Lian, H. Lei, S. Cheng, R. Zheng, H. Yao, J. Chen, T. Chen
• Journal: MedComm
• Published: 2023;4(2):e241
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

In plain English

This short letter used the Surveillance, Epidemiology, and End Results (SEER) cancer database, 2004 to 2015, to ask whether radiotherapy was linked to longer survival in malignant pleural mesothelioma. It did not study asbestos exposure. Of 7,299 patients, 803 (11%) had radiotherapy. Before matching, median survival was 12 months with radiotherapy and 8 months without (hazard ratio 0.761, 95% confidence interval 0.705–0.821). After matching 803 radiotherapy patients with 803 similar patients without it, the hazard ratio was 0.868 (95% CI 0.785–0.961, p = 0.006). Adding radiotherapy to chemotherapy showed no clear difference (13 vs. 12 months, p = 0.644). Median survival was 20 months with surgery, chemotherapy and radiotherapy combined, versus 11 months with radiotherapy plus chemotherapy or surgery. Among 93 patients whose cancer had spread to bone but not to the lung, liver or brain, median survival was 6 months with radiotherapy and 3 months without (p = 0.16). The authors concluded that radiotherapy could improve prognosis but saw no survival advantage with bone or lung metastases. They noted a lack of detailed radiation information and selection bias.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective analysis of a cancer registry database (SEER), using 1:1 propensity score matching to compare patients who did and did not receive radiotherapy; published as a letter
• Who was studied: 7,299 patients with pathologically confirmed malignant pleural mesothelioma in the SEER database, diagnosed January 1, 2004 to December 31, 2015; median age at diagnosis 74 years; 79% male; 803 (11%) received radiotherapy
• Exposure: No asbestos exposure was studied. The exposure compared was radiotherapy for the primary tumor, alone or combined with surgery and/or chemotherapy. No radiation dose or technique details were available.
• Main results:
  • Before matching, in all patients: median overall survival 12 months in the radiotherapy group vs. 8 months in the no-radiotherapy group; HR 0.761, 95% CI 0.705–0.821, p less than 0.001
  • After propensity score matching (803 patients per group): HR 0.868, 95% CI 0.785–0.961, p = 0.006, favoring radiotherapy
  • 93 patients with bone metastases, not including those who also had lung, liver or brain metastases: median overall survival 6 months in the radiotherapy group vs. 3 months in the no-radiotherapy group; HR 0.725, 95% CI 0.463–1.135, p = 0.16
  • 142 patients with lung metastases but without liver, bone or brain metastases: the article reports 2 months vs. 8 months and states that radiotherapy 'could reduce the OS'. No hazard ratio or p-value is given.
  • Radiotherapy plus surgery vs. radiotherapy alone (as the article words it): median overall survival 19 vs. 13 months; HR 0.758, 95% CI 0.659–0.872, p less than 0.001
  • Radiotherapy plus chemotherapy vs. chemotherapy alone: median overall survival 13 vs. 12 months; HR 0.970, 95% CI 0.850–1.106, p = 0.644
  • Trimodality therapy (surgery, chemotherapy and radiotherapy) vs. radiotherapy with chemotherapy or surgery: median overall survival 20 vs. 11 months; HR 0.612, 95% CI 0.518–0.722, p less than 0.001
  • In univariate and multivariate regression, younger age, female sex, early TNM stage, surgery, chemotherapy and radiotherapy were identified as potential protective factors
• The authors' conclusion: The authors concluded that radiotherapy could improve the clinical prognosis of malignant pleural mesothelioma patients. They also concluded that no survival advantage was seen in those with bone or lung metastases, and that well-designed clinical trials are needed.
• Limitations the authors state:
  • No specific information on the radiation given, and selection bias
  • Few patients with lung or bone metastases received radiotherapy, which may have limited statistical power

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma.

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