Effectiveness of radiation therapy alone for elderly patients with unresected stage III non-small cell lung cancer
Keith Sigel, Linda Lurslurchachai, Marcelo Bonomi, Grace Mhango, Cara Bergamo, Minal Kale, Ethan Halm, Juan Wisnivesky, Keith Sigel, Linda Lurslurchachai, Marcelo Bonomi, Grace Mhango, Cara Bergamo, Minal Kale, Ethan Halm, Juan Wisnivesky
Abstract
Purpose: Chemoradiotherapy is the standard of care for unresectable stage III non-small cell lung cancer (NSCLC). Elderly patients, who are often considered unfit for combined chemoradiotherapy, frequently receive radiation therapy (RT) alone. Using population-based data, we evaluated the effectiveness and tolerability of lone RT in unresected elderly stage III NSCLC patients.
Methods and materials: Using the Surveillance, Epidemiology and End Results (SEER) registry linked to Medicare records we identified 10,376 cases of unresected stage III NSCLC that were not treated with chemotherapy, diagnosed between 1992 and 2007. We used logistic regression to determine propensity scores for RT treatment using patients' pre-treatment characteristics. We then compared survival of patients who underwent lone RT vs. no treatment using a Cox regression model adjusting for propensity scores. The adjusted odds for toxicity among patients treated with and without RT were also estimated.
Results: Overall, 6468 (62%) patients received lone RT. Adjusted analyses showed that RT was associated with improved overall survival in unresected stage III NCSLC (hazard ratio [HR]: 0.76; 95% confidence interval [CI]: 0.74-0.79) after controlling for propensity scores. RT treated patients had an increased adjusted risk of hospitalization for pneumonitis (odds ratio [OR]: 89, 95% CI: 12-636), and esophagitis (OR: 8, 95% CI: 3-21).
Conclusions: These data suggest that use of RT alone may improve the outcomes of elderly patients with unresected stage III NSCLC. Severe toxicity, however, was considerably higher in the RT treated group. The potential risks and benefits of RT should be carefully discussed with eligible elderly NSCLC patients.
Keywords: CI; CPT; Current Procedural Terminology; Elderly; HR; Lone radiotherapy; NSCLC; Non-small cell lung cancer; OR; OS; Outcomes; PET; RCT; RT; Radiotherapy; SEER; Surveillance, Epidemiology and End Results; Toxicity; Unresectable lung cancer; confidence interval; hazard ratio; non-small cell lung cancer; odds ratio; overall survival; positron emission tomography; radiotherapy; randomized controlled trial.
Conflict of interest statement
Conflicts of Interest
None declared.
Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Source: PubMed