Intensity Modulated Radiation Therapy versus Supportive Care in Malignant Pleural Mesothelioma: A Pilot Study for Treatment Outcomes and Cost-Effective Expectations

Abstract

Background: Malignant pleural mesothelioma (MPM) is an aggressive tumor. The outcome of treatment of EgyptianMPM patients is not satisfactory and its cost-effectiveness is questionable.Aim: The study aimed to test the treatment outcome and cost-effectiveness of intensity modulated radiation therapy(IMRT) in unresectable MPM patients who exhausted the standard treatment modalities.Methods: Twenty-four eligible patients were randomized (1:1) to either a control group receiving best supportive care(BSC) or an intervention group receiving IMRT to the tumor volume. Quality of life (QoL) was assessed by the EuropeanOrganization for Research and Treatment of Cancer QoL questionnaires QLQ-C30 and QLQ-LC13 (lung cancer module).Tumor progression was monitored by serial computerized tomography scans. Assessment was done at enrollment and after4 months. Incremental cost-effectiveness ratio (ICER) was calculated for BSC vs. IMRT. The output data of the ICERwere total costs, overall survival (OS), progression-free survival (PFS) for each treatment modality.Results: The median OS did not differ significantly between IMRT and BSC (13 versus 11 months, respectively; p=0.117)while the median PFS was significantly longer with IMRT (6 versus 4 months, respectively; p=0.009). The IMRT groupdemonstrated a significant deterioration in their final QoL scores compared to baseline. IMRT had an incremental cost of5912 USD per patient with an incremental effectiveness of 4 months of PFS, providing an ICER of 6.260.Conclusion: Although it may be associated with longer PFS, IMRT in MPM with intact lung is likely detrimental and notcost-effective.