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

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)266-270
Number of pages5
JournalLung Cancer
Volume82
Issue number2
DOIs
StatePublished - Nov 2013

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Non-Small Cell Lung Carcinoma
Radiotherapy
Propensity Score
Chemoradiotherapy
Confidence Intervals
Odds Ratio
Survival
Esophagitis
Standard of Care
Medicare
Proportional Hazards Models
Registries
Pneumonia
Epidemiology
Hospitalization
Therapeutics
Logistic Models
Drug Therapy

Keywords

  • Elderly
  • Lone radiotherapy
  • Non-small cell lung cancer
  • Outcomes
  • Radiotherapy
  • Toxicity
  • Unresectable lung cancer

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

Sigel, K., Lurslurchachai, L., Bonomi, M., Mhango, G., Bergamo, C., Kale, M., ... Wisnivesky, J. (2013). Effectiveness of radiation therapy alone for elderly patients with unresected stage III non-small cell lung cancer. Lung Cancer, 82(2), 266-270. https://doi.org/10.1016/j.lungcan.2013.06.011

Effectiveness of radiation therapy alone for elderly patients with unresected stage III non-small cell lung cancer. / Sigel, Keith; Lurslurchachai, Linda; Bonomi, Marcelo; Mhango, Grace; Bergamo, Cara; Kale, Minal; Halm, Ethan; Wisnivesky, Juan.

In: Lung Cancer, Vol. 82, No. 2, 11.2013, p. 266-270.

Research output: Contribution to journalArticle

Sigel, K, Lurslurchachai, L, Bonomi, M, Mhango, G, Bergamo, C, Kale, M, Halm, E & Wisnivesky, J 2013, 'Effectiveness of radiation therapy alone for elderly patients with unresected stage III non-small cell lung cancer', Lung Cancer, vol. 82, no. 2, pp. 266-270. https://doi.org/10.1016/j.lungcan.2013.06.011
Sigel, Keith ; Lurslurchachai, Linda ; Bonomi, Marcelo ; Mhango, Grace ; Bergamo, Cara ; Kale, Minal ; Halm, Ethan ; Wisnivesky, Juan. / Effectiveness of radiation therapy alone for elderly patients with unresected stage III non-small cell lung cancer. In: Lung Cancer. 2013 ; Vol. 82, No. 2. pp. 266-270.
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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.",
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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.

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KW - Lone radiotherapy

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KW - Radiotherapy

KW - Toxicity

KW - Unresectable lung cancer

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