Adjuvant chemotherapy following stereotactic body radiotherapy for early stage non-small-cell lung cancer is associated with lower overall

A National Cancer Database Analysis

Corey C. Foster, Chad G. Rusthoven, David J Sher, Lawrence Feldman, Mary Pasquinelli, Michael T. Spiotto, Matthew Koshy

Research output: Contribution to journalArticle

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Abstract

Objectives: Adjuvant chemotherapy is routinely offered post-surgical resection for early stage non-small-cell lung cancer (NSCLC) ≥4 cm; however, its role following definitive stereotactic body radiotherapy (SBRT) has not been well defined. We investigated the association between receipt of adjuvant chemotherapy post-SBRT and overall survival (OS) for patients with T1-T3N0M0 NSCLC in the National Cancer Database (NCDB). Materials and Methods: The NCDB was queried for patients with T1-T3N0M0 NSCLC treated with definitive SBRT from 2004 to 2014. The association between non-randomized receipt of adjuvant chemotherapy and OS was analyzed for all patients (n = 24,011) and a propensity-matched cohort (n = 608) using Kaplan-Meier methods and Cox proportional hazard models. A subset analysis was performed for patients with tumors ≥4 cm (n = 2,323). Results: There were 24,011 patients in the cohort with a median follow-up of 32.5 months. Of these, 322 (1.3%) received adjuvant chemotherapy. Three-year OS was 41.3% with adjuvant chemotherapy compared to 50.6% without adjuvant chemotherapy (p = 0.001). On multivariate analysis, adjuvant chemotherapy was independently associated with higher overall mortality (hazard ratio:1.22, 95% confidence interval:1.06–1.40, p = 0.005). For tumors ≥4 cm, 3-year OS was 38.2% with adjuvant chemotherapy (n = 80) compared to 33.0% without adjuvant chemotherapy (p = 0.81). After propensity-score matching, there was a persistent association between lower OS and adjuvant chemotherapy with those receiving adjuvant chemotherapy (n = 322) having 3-year OS of 41.3% compared to 60.9% without adjuvant chemotherapy (p < 0.0001). Conclusion: Adjuvant chemotherapy following definitive SBRT for T1-3N0M0 NSCLC is associated with lower OS and is not associated with a survival benefit for patients with tumors ≥4 cm.

Original languageEnglish (US)
Pages (from-to)162-168
Number of pages7
JournalLung Cancer
Volume130
DOIs
StatePublished - Apr 1 2019

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Radiosurgery
Adjuvant Chemotherapy
Non-Small Cell Lung Carcinoma
Databases
Neoplasms
Survival
Propensity Score
Proportional Hazards Models
Multivariate Analysis

Keywords

  • Adjuvant chemotherapy
  • National Cancer Database
  • Non-small-cell lung cancer
  • Stereotactic body radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

Adjuvant chemotherapy following stereotactic body radiotherapy for early stage non-small-cell lung cancer is associated with lower overall : A National Cancer Database Analysis. / Foster, Corey C.; Rusthoven, Chad G.; Sher, David J; Feldman, Lawrence; Pasquinelli, Mary; Spiotto, Michael T.; Koshy, Matthew.

In: Lung Cancer, Vol. 130, 01.04.2019, p. 162-168.

Research output: Contribution to journalArticle

Foster, Corey C. ; Rusthoven, Chad G. ; Sher, David J ; Feldman, Lawrence ; Pasquinelli, Mary ; Spiotto, Michael T. ; Koshy, Matthew. / Adjuvant chemotherapy following stereotactic body radiotherapy for early stage non-small-cell lung cancer is associated with lower overall : A National Cancer Database Analysis. In: Lung Cancer. 2019 ; Vol. 130. pp. 162-168.
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title = "Adjuvant chemotherapy following stereotactic body radiotherapy for early stage non-small-cell lung cancer is associated with lower overall: A National Cancer Database Analysis",
abstract = "Objectives: Adjuvant chemotherapy is routinely offered post-surgical resection for early stage non-small-cell lung cancer (NSCLC) ≥4 cm; however, its role following definitive stereotactic body radiotherapy (SBRT) has not been well defined. We investigated the association between receipt of adjuvant chemotherapy post-SBRT and overall survival (OS) for patients with T1-T3N0M0 NSCLC in the National Cancer Database (NCDB). Materials and Methods: The NCDB was queried for patients with T1-T3N0M0 NSCLC treated with definitive SBRT from 2004 to 2014. The association between non-randomized receipt of adjuvant chemotherapy and OS was analyzed for all patients (n = 24,011) and a propensity-matched cohort (n = 608) using Kaplan-Meier methods and Cox proportional hazard models. A subset analysis was performed for patients with tumors ≥4 cm (n = 2,323). Results: There were 24,011 patients in the cohort with a median follow-up of 32.5 months. Of these, 322 (1.3{\%}) received adjuvant chemotherapy. Three-year OS was 41.3{\%} with adjuvant chemotherapy compared to 50.6{\%} without adjuvant chemotherapy (p = 0.001). On multivariate analysis, adjuvant chemotherapy was independently associated with higher overall mortality (hazard ratio:1.22, 95{\%} confidence interval:1.06–1.40, p = 0.005). For tumors ≥4 cm, 3-year OS was 38.2{\%} with adjuvant chemotherapy (n = 80) compared to 33.0{\%} without adjuvant chemotherapy (p = 0.81). After propensity-score matching, there was a persistent association between lower OS and adjuvant chemotherapy with those receiving adjuvant chemotherapy (n = 322) having 3-year OS of 41.3{\%} compared to 60.9{\%} without adjuvant chemotherapy (p < 0.0001). Conclusion: Adjuvant chemotherapy following definitive SBRT for T1-3N0M0 NSCLC is associated with lower OS and is not associated with a survival benefit for patients with tumors ≥4 cm.",
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T1 - Adjuvant chemotherapy following stereotactic body radiotherapy for early stage non-small-cell lung cancer is associated with lower overall

T2 - A National Cancer Database Analysis

AU - Foster, Corey C.

AU - Rusthoven, Chad G.

AU - Sher, David J

AU - Feldman, Lawrence

AU - Pasquinelli, Mary

AU - Spiotto, Michael T.

AU - Koshy, Matthew

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Objectives: Adjuvant chemotherapy is routinely offered post-surgical resection for early stage non-small-cell lung cancer (NSCLC) ≥4 cm; however, its role following definitive stereotactic body radiotherapy (SBRT) has not been well defined. We investigated the association between receipt of adjuvant chemotherapy post-SBRT and overall survival (OS) for patients with T1-T3N0M0 NSCLC in the National Cancer Database (NCDB). Materials and Methods: The NCDB was queried for patients with T1-T3N0M0 NSCLC treated with definitive SBRT from 2004 to 2014. The association between non-randomized receipt of adjuvant chemotherapy and OS was analyzed for all patients (n = 24,011) and a propensity-matched cohort (n = 608) using Kaplan-Meier methods and Cox proportional hazard models. A subset analysis was performed for patients with tumors ≥4 cm (n = 2,323). Results: There were 24,011 patients in the cohort with a median follow-up of 32.5 months. Of these, 322 (1.3%) received adjuvant chemotherapy. Three-year OS was 41.3% with adjuvant chemotherapy compared to 50.6% without adjuvant chemotherapy (p = 0.001). On multivariate analysis, adjuvant chemotherapy was independently associated with higher overall mortality (hazard ratio:1.22, 95% confidence interval:1.06–1.40, p = 0.005). For tumors ≥4 cm, 3-year OS was 38.2% with adjuvant chemotherapy (n = 80) compared to 33.0% without adjuvant chemotherapy (p = 0.81). After propensity-score matching, there was a persistent association between lower OS and adjuvant chemotherapy with those receiving adjuvant chemotherapy (n = 322) having 3-year OS of 41.3% compared to 60.9% without adjuvant chemotherapy (p < 0.0001). Conclusion: Adjuvant chemotherapy following definitive SBRT for T1-3N0M0 NSCLC is associated with lower OS and is not associated with a survival benefit for patients with tumors ≥4 cm.

AB - Objectives: Adjuvant chemotherapy is routinely offered post-surgical resection for early stage non-small-cell lung cancer (NSCLC) ≥4 cm; however, its role following definitive stereotactic body radiotherapy (SBRT) has not been well defined. We investigated the association between receipt of adjuvant chemotherapy post-SBRT and overall survival (OS) for patients with T1-T3N0M0 NSCLC in the National Cancer Database (NCDB). Materials and Methods: The NCDB was queried for patients with T1-T3N0M0 NSCLC treated with definitive SBRT from 2004 to 2014. The association between non-randomized receipt of adjuvant chemotherapy and OS was analyzed for all patients (n = 24,011) and a propensity-matched cohort (n = 608) using Kaplan-Meier methods and Cox proportional hazard models. A subset analysis was performed for patients with tumors ≥4 cm (n = 2,323). Results: There were 24,011 patients in the cohort with a median follow-up of 32.5 months. Of these, 322 (1.3%) received adjuvant chemotherapy. Three-year OS was 41.3% with adjuvant chemotherapy compared to 50.6% without adjuvant chemotherapy (p = 0.001). On multivariate analysis, adjuvant chemotherapy was independently associated with higher overall mortality (hazard ratio:1.22, 95% confidence interval:1.06–1.40, p = 0.005). For tumors ≥4 cm, 3-year OS was 38.2% with adjuvant chemotherapy (n = 80) compared to 33.0% without adjuvant chemotherapy (p = 0.81). After propensity-score matching, there was a persistent association between lower OS and adjuvant chemotherapy with those receiving adjuvant chemotherapy (n = 322) having 3-year OS of 41.3% compared to 60.9% without adjuvant chemotherapy (p < 0.0001). Conclusion: Adjuvant chemotherapy following definitive SBRT for T1-3N0M0 NSCLC is associated with lower OS and is not associated with a survival benefit for patients with tumors ≥4 cm.

KW - Adjuvant chemotherapy

KW - National Cancer Database

KW - Non-small-cell lung cancer

KW - Stereotactic body radiotherapy

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