Postoperative radiotherapy for elderly patients with stage III lung cancer

Juan P. Wisnivesky, Ethan A. Halm, Marcelo Bonomi, Cardinale Smith, Grace Mhango, Emilia Bagiella

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

BACKGROUND: The potential role of postoperative radiation therapy (PORT) for patients who have completely resected, stage III nonsmall cell lung cancer (NSCLC) with N2 disease remains controversial. By using population-based data, the authors of this report compared the survival of a concurrent cohort of elderly patients who had N2 disease treated with and without PORT. METHODS: By using the Surveillance, Epidemiology, and End Results (SEER) registry linked to Medicare records, 1307 patients were identified who had stage III NSCLC with N2 lymph node involvement diagnosed between 1992 and 2005. Propensity scoring methods and instrumental variable analysis were used to compare the survival of patients who did and did not receive PORT after controlling for selection bias. RESULTS: Overall, 710 patients (54%) received PORT. Propensity score analysis indicated that PORT was not associated with improved survival in patients with N2 disease (hazard ratio [HR], 1.11; 95% confidence interval [CI], 0.97-1.27). Analyses that were limited to patients who did or did not receive chemotherapy, who received intermediate-complexity or high-complexity radiotherapy planning, or adjusted for time trends produced similar results. The instrumental variable estimator for the absolute improvement in 1-year and 3-year survival with PORT was -0.04 (95% CI, -0.15 to 0.08) and -0.08 (95% CI, -0.24 to 0.15), respectively. CONCLUSIONS: The current data suggested that PORT is not associated with improved survival for elderly patients with N2 disease. These findings have important clinical implications, because SEER data indicate that a large percentage of elderly patients currently receive PORT despite the lack of definitive evidence about its effectiveness. The potential effectiveness of PORT should be evaluated further in randomized controlled trials. Cancer 2012. © 2012 American Cancer Society. The potential role of postoperative radiation therapy for patients with completely resected, stage III nonsmall cell lung cancer who have N2 disease remains controversial. By using several methods to control for selection bias, the results from this study indicate that postoperative radiotherapy is not associated with improved survival in elderly patients with N2 disease.

Original languageEnglish (US)
Pages (from-to)4478-4485
Number of pages8
JournalCancer
Volume118
Issue number18
DOIs
StatePublished - Sep 15 2012

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Lung Neoplasms
Radiotherapy
Survival
Non-Small Cell Lung Carcinoma
Selection Bias
Confidence Intervals
Epidemiology
Propensity Score
Medicare
Registries
Research Design
Randomized Controlled Trials
Lymph Nodes
Drug Therapy

Keywords

  • lung cancer
  • N2 disease
  • postoperative radiotherapy
  • survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Wisnivesky, J. P., Halm, E. A., Bonomi, M., Smith, C., Mhango, G., & Bagiella, E. (2012). Postoperative radiotherapy for elderly patients with stage III lung cancer. Cancer, 118(18), 4478-4485. https://doi.org/10.1002/cncr.26585

Postoperative radiotherapy for elderly patients with stage III lung cancer. / Wisnivesky, Juan P.; Halm, Ethan A.; Bonomi, Marcelo; Smith, Cardinale; Mhango, Grace; Bagiella, Emilia.

In: Cancer, Vol. 118, No. 18, 15.09.2012, p. 4478-4485.

Research output: Contribution to journalArticle

Wisnivesky, JP, Halm, EA, Bonomi, M, Smith, C, Mhango, G & Bagiella, E 2012, 'Postoperative radiotherapy for elderly patients with stage III lung cancer', Cancer, vol. 118, no. 18, pp. 4478-4485. https://doi.org/10.1002/cncr.26585
Wisnivesky JP, Halm EA, Bonomi M, Smith C, Mhango G, Bagiella E. Postoperative radiotherapy for elderly patients with stage III lung cancer. Cancer. 2012 Sep 15;118(18):4478-4485. https://doi.org/10.1002/cncr.26585
Wisnivesky, Juan P. ; Halm, Ethan A. ; Bonomi, Marcelo ; Smith, Cardinale ; Mhango, Grace ; Bagiella, Emilia. / Postoperative radiotherapy for elderly patients with stage III lung cancer. In: Cancer. 2012 ; Vol. 118, No. 18. pp. 4478-4485.
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abstract = "BACKGROUND: The potential role of postoperative radiation therapy (PORT) for patients who have completely resected, stage III nonsmall cell lung cancer (NSCLC) with N2 disease remains controversial. By using population-based data, the authors of this report compared the survival of a concurrent cohort of elderly patients who had N2 disease treated with and without PORT. METHODS: By using the Surveillance, Epidemiology, and End Results (SEER) registry linked to Medicare records, 1307 patients were identified who had stage III NSCLC with N2 lymph node involvement diagnosed between 1992 and 2005. Propensity scoring methods and instrumental variable analysis were used to compare the survival of patients who did and did not receive PORT after controlling for selection bias. RESULTS: Overall, 710 patients (54{\%}) received PORT. Propensity score analysis indicated that PORT was not associated with improved survival in patients with N2 disease (hazard ratio [HR], 1.11; 95{\%} confidence interval [CI], 0.97-1.27). Analyses that were limited to patients who did or did not receive chemotherapy, who received intermediate-complexity or high-complexity radiotherapy planning, or adjusted for time trends produced similar results. The instrumental variable estimator for the absolute improvement in 1-year and 3-year survival with PORT was -0.04 (95{\%} CI, -0.15 to 0.08) and -0.08 (95{\%} CI, -0.24 to 0.15), respectively. CONCLUSIONS: The current data suggested that PORT is not associated with improved survival for elderly patients with N2 disease. These findings have important clinical implications, because SEER data indicate that a large percentage of elderly patients currently receive PORT despite the lack of definitive evidence about its effectiveness. The potential effectiveness of PORT should be evaluated further in randomized controlled trials. Cancer 2012. {\circledC} 2012 American Cancer Society. The potential role of postoperative radiation therapy for patients with completely resected, stage III nonsmall cell lung cancer who have N2 disease remains controversial. By using several methods to control for selection bias, the results from this study indicate that postoperative radiotherapy is not associated with improved survival in elderly patients with N2 disease.",
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