Outcomes after adjuvant platinum-based chemotherapy in elderly NSCLC patients with T4 disease

Keith Sigel, Grace Mhango, Jessica Cohen, Ethan A. Halm, John Mandeli, Gary Strauss, Juan Wisnivesky

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Background: The postoperative management of elderly patients with T4, N0-1, M0 non-small cell lung cancer (NSCLC) remains controversial. The objective of this study was to evaluate the association of adjuvant chemotherapy with survival and toxicity among these patients. Methods: Using surveillance, epidemiology and end results registry data linked to Medicare claims, we identified 389 elderly patients with resected T4, N0-1, M0 NSCLC diagnosed between 1992 and 2007. We compared survival of patients treated with and without platinum-based chemotherapy using a Cox regression adjusting for propensity scores for chemotherapy use and use of radiotherapy. We used logistic regression to assess the risk of adverse events in patients receiving chemotherapy. Results: No benefit was noted in overall survival with adjuvant chemotherapy after PS adjustment for both N0 (hazard ratio 0.78, 95 % confidence interval 0.50-1.23) and N1 (hazard ratio 1.01, 95 % confidence interval 0.67-1.53) cancers. Patients receiving adjuvant chemotherapy experienced severe adverse events more frequently than patients who did not receive chemotherapy. Conclusions: Use of adjuvant chemotherapy in elderly patients with T4, N0-1, M0 NSCLC was not associated with a survival advantage and was associated with higher rates of severe toxicity.

Original languageEnglish (US)
Pages (from-to)1013-1019
Number of pages7
JournalAnnals of Surgical Oncology
Volume20
Issue number3
DOIs
StatePublished - Mar 1 2013

ASJC Scopus subject areas

  • Surgery
  • Oncology

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