Postoperative radiotherapy for elderly patients with stage III lung cancer§

Authors

  • Juan P. Wisnivesky MD, DrPh,

    Corresponding author
    1. Division of General Internal Medicine, Mount Sinai School of Medicine, New York, New York
    2. Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai School of Medicine, New York, New York
    • Department of Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1087, New York, NY 10029

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    • Fax: (212) 824-2317

  • Ethan A. Halm MD, MPH,

    1. Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
    2. Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
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  • Marcelo Bonomi MD,

    1. Division of Hematology-Oncology, Mount Sinai School of Medicine, New York, New York
    2. Division of Palliative Care Medicine, Mount Sinai School of Medicine, New York, New York
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  • Cardinale Smith MD,

    1. Division of Hematology-Oncology, Mount Sinai School of Medicine, New York, New York
    2. Division of Palliative Care Medicine, Mount Sinai School of Medicine, New York, New York
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  • Grace Mhango MPH,

    1. Division of General Internal Medicine, Mount Sinai School of Medicine, New York, New York
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  • Emilia Bagiella PhD

    1. Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
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  • We acknowledge the efforts of the Applied Research Branch, Division of Cancer Prevention and Population Science, National Cancer Institute; the Office of Information Services and the Office of Strategic Planning, Health Care Finance Administration; Information Management Services, Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare Database. The interpretation and reporting of these data are the sole responsibilities of the authors.

  • The sponsors of the study had no role in the study design, data collection, analysis, and interpretation, or writing of the report.

  • §

    Dr. Wisnivesky had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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.

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