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Effectiveness of Radiation Therapy for Elderly Patients with Unresected Stage I and II Non–Small Cell Lung Cancer

¹ Divisions of General Internal Medicine and ² Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai School of Medicine, New York, New York; ³ Departments of Internal Medicine and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas; ⁴ Divisions of Hematology-Oncology and Palliative Care Medicine, Mount Sinai School of Medicine, New York; ⁵ Division of Pulmonary and Critical Care Medicine, and ⁶ Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York

Correspondence and requests for reprints should be addressed to Juan P. Wisnivesky, M.D., Dr.PH., Department of Medicine Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1087, New York, NY 10029. E-mail: juan.wisnivesky{at}mssm.edu

Rationale: Radiotherapy (RT) is considered the standard treatment for patients with stage I or II non–small lung cancer who are not surgical candidates because of comorbities or preferences against surgery.

Objectives: To compare the outcomes of patients treated with RT alone with those who were untreated to assess the effect of RT on survival.

Methods: Using the Surveillance, Epidemiology and End Results (SEER) registry linked to Medicare files, we identified 6,065 unresected patients with histologically confirmed stage I and stage II non–small cell lung cancer, diagnosed between 1992 and 2002. We used propensity score methods and instrumental variable analysis to control for the possible effects of known as well as unmeasured confounders.

Measurements and Main Results: Overall, 59% of patients received RT. The overall and lung cancer–specific survival of unresected patients treated with RT was significantly better compared with the untreated cases (P < 0.0001 for both comparisons). RT was associated with a 6-month improvement in median overall survival. Propensity score analyses showed that RT was associated with improved overall (hazard ratio, 0.74; 95% confidence interval, 0.70–0.78) and lung cancer–specific survival (hazard ratio, 0.73; 95% confidence interval, 0.69–0.78). Instrumental variable analysis also indicated improved outcomes among patients treated with RT.

Conclusions: RT improves survival of elderly patients with unresected stage I or II lung cancer. These results should be confirmed in prospective trials.

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Radiation therapy is considered the standard of care for patients with unresected stage I and II lung cancer. Despite the frequent use of radiotherapy for these patients, limited data is available regarding its effectiveness. What This Study Adds to the Field Using several methods to control for selection bias, we showed that radiotherapy improves survival in a large population-based sample of elderly patients with stage I and II lung cancer who did not undergo resection due to comorbidities or preferences against surgery.

 

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Optimal Therapy for Elderly Patients with Early Stage Non–Small Cell Lung Cancer

Paul A. Bunn, Jr.
AJRCCM 2010 181: 201-202. [Full Text]  

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				P. A. Bunn Jr. Optimal Therapy for Elderly Patients with Early Stage Non-Small Cell Lung Cancer Am. J. Respir. Crit. Care Med., February 1, 2010; 181(3): 201 - 202. [Full Text] [PDF]