Author of

• 35262

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  P24 - Mesothelioma, Thymoma and Other Thoracic Malignancies - Mesothelioma Clinical and Trials in Progress (ID 138)

  • Event: WCLC 2020
  • Type: Posters
  • Track: Mesothelioma, Thymoma and Other Thoracic Malignancies
  • Presentations: 1
  • Moderators:
  • Coordinates: 1/28/2021, 00:00 - 01:00, ePoster Hall

  • 35267

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    P24.04 - Outcome of Neoadjuvant or Adjuvant Radiotherapy in Multimodality Setting with EPP for Malignant Pleural Mesothelioma (ID 2336)

    00:00 - 01:00  |  Presenting Author(s): Alireza Hoda
    • Abstract
    • Slides

    Introduction
    

    Extrapleural pneumonectomy (EPP) was reported to offer favourable long-term outcome for selected patients with malignant pleural mesothelioma (MPM) when performed within a multimodality setting including chemo- and/or radiotherapy. The optimal sequence of treatment modalities, however, is yet to be defined. We analysed peri-operative morbidity and long long-term outcome of patients who underwent EPP when combined with neoadjuvant or adjuvant pleural intensity modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT) with or without chemotherapy in a real-world setting at a tertiary thoracic oncology reference center.

    Methods
    

    Our prospective single-center database was reviewed for patients undergoing a curative intent treatment protocol including EPP and IMRT/VMAT and partly chemotherapy between 2005 and 2018, and retrospectively analyzed.

    Results
    

    In total, 59 patients (mean age 59 years; male, n=48 (81%)) were identified. 47 patients underwent the institutional standard trimodality treatment consisting of induction chemotherapy, EPP, and adjuvant pleural IMRT/VMAT (adjuvant IMRT/VMAT group). Starting from 2016, neoadjuvant IMRT/VMAT was included in the institutional standard approach, and 12 patients received neoadjuvant IMRT/VMAT with prior (n=9) or without (n=3) chemotherapy followed by EPP (neoadjuvant IMRT/VMAT group). Most patients had the histological epitheloid subtype (85%) and pathological stage I disease (79%, TNM 8^thEdition). The postoperative all-case complication rate was 45% without differences between neoadjuvant or adjuvant IMRT/VMAT. The median overall survival (OS) of all patients was 23 months, and 3- and 5-year OS rates were 31% and 25%, respectively. There was no significant survival difference between patients receiving neoadjuvant versus adjuvant IMRT/VMAT with slightly prolonged OS after adjuvant IMRT/VMAT (median OS 24 vs. 17 months, hazard ratio 0.717, p=0.39).

    Conclusion
    

    Neoadjuvant pleural IMRT/VMAT prior to EPP is currently investigated as a new treatment option for highly selected MPM patients. Within our initial limited real-world single-center experience, neoadjuvant IMRT/VMAT with prior or without prior chemotherapy was safe, but showed no relevant survival benefit compared to adjuvant IMRT/VMAT in a multimodality treatment setting.

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