Intensity Modulated Radiation Therapy versus Supportive Care in Malignant Pleural Mesothelioma: A Pilot Study for Treatment Outcomes and Cost-Effective Expectations | ||||
| Research in Oncology | ||||
| Article 3, Volume 14, Issue 1, June 2018, Page 6-11 PDF (375.05 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/resoncol.2018.2409.1042 | ||||
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| Authors | ||||
Mahmoud Ellithy  1; Nermeen Ashoush2; Khalid El Shahat3; Emad Ahmed4; Mahmoud Abdelsalam5
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| 1Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt | ||||
| 2Clinical Pharmacy Department, Faculty of Pharmacy, British University in Cairo, Cairo, Egypt | ||||
| 3Clinical Oncology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt | ||||
| 4Radiation physics Department, International Medical Center, Medical branch of Egyptian Armed Forces, Cairo, Egypt | ||||
| 5Hematology Oncology Department, International Medical Center, Medical branch of Egyptian Armed Forces, Cairo, Egypt. | ||||
| Abstract | ||||
| Background: Malignant pleural mesothelioma (MPM) is an aggressive tumor. The outcome of treatment of Egyptian MPM 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 European Organization 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 after 4 months. Incremental cost-effectiveness ratio (ICER) was calculated for BSC vs. IMRT. The output data of the ICER were 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 group < br />demonstrated a significant deterioration in their final QoL scores compared to baseline. IMRT had an incremental cost of 5912 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 not cost-effective. | ||||
| Keywords | ||||
| Malignant Pleural Mesothelioma; intensity modulated radiation therapy; quality of life; Cost-effectiveness; Egypt | ||||
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