TY - JOUR
T1 - Effectiveness of radiation therapy alone for elderly patients with unresected stage III non-small cell lung cancer
AU - Sigel, Keith
AU - Lurslurchachai, Linda
AU - Bonomi, Marcelo
AU - Mhango, Grace
AU - Bergamo, Cara
AU - Kale, Minal
AU - Halm, Ethan
AU - Wisnivesky, Juan
N1 - Funding Information:
This study was supported by the National Center for Research Resources ( KL2RR029885 to KS), the National Cancer Institute ( 5R01CA131348-3 ), and the Center for Advancing Translational Sciences ( UL1TR000067 ).
PY - 2013/11
Y1 - 2013/11
N2 - 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.
AB - 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.
KW - Elderly
KW - Lone radiotherapy
KW - Non-small cell lung cancer
KW - Outcomes
KW - Radiotherapy
KW - Toxicity
KW - Unresectable lung cancer
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U2 - 10.1016/j.lungcan.2013.06.011
DO - 10.1016/j.lungcan.2013.06.011
M3 - Article
C2 - 24011407
AN - SCOPUS:84887017079
SN - 0169-5002
VL - 82
SP - 266
EP - 270
JO - Lung Cancer
JF - Lung Cancer
IS - 2
ER -