Elisabeth Driessen1, Deniece Detillon2, Gerbern Bootsma3, Dirk De Ruysscher4, Eelco Veen5, Mieke Aarts6, Maryska Janssen-Heijnen7. 1. Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, Maastricht University Medical Centre+, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands. Electronic address: lizzy_driessen@hotmail.com. 2. Department of Surgery, Amphia Hospital, Breda, the Netherlands. Electronic address: DDetillon@amphia.nl. 3. Department of Pulmonology, Zuyderland Medical Centre, Heerlen, the Netherlands. Electronic address: g.bootsma@zuyderland.nl. 4. Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands. Electronic address: dirk.deruysscher@maastro.nl. 5. Department of Surgery, Amphia Hospital, Breda, the Netherlands. Electronic address: EVeen@amphia.nl. 6. Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands. Electronic address: m.aarts@iknl.nl. 7. Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, Maastricht University Medical Centre+, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands. Electronic address: mjanssenheijnen@viecuri.nl.
Abstract
OBJECTIVES: Insights regarding utilization and survival of surgery and radiotherapy (stereotactic body radiotherapy (SBRT) or conventional radiotherapy (RT)) are lacking for older patients with stage I and II non-small cell lung cancer (NSCLC) in clinical practice. METHODS: Data from the Netherlands Cancer Registry were retrieved for patients ≥65 years with clinical stage I-II NSCLC in 2010-2015. Descriptive analyses, overall survival (OS), and cox regression were stratified for stage I (n = 8742) and II (n = 3439) and compared age groups (65-74 years vs ≥75 years). RESULTS: Patients aged 65-74 underwent surgery significantly more often compared to those aged ≥75 (stage I 55% vs 27%; stage II: 65% vs 35%), and received SBRT less often (I: 29% vs 42%; II: 5% vs 11%), conventional RT less often (I: 6% vs 11%; II 10% vs 24%) and best supportive care alone less often (BSC, I: 8% vs 19%; II: 9% vs 25%). One-year OS was significantly higher in patients aged 65-74 compared to those aged ≥75 (I: 87% vs 78%; II: 74% vs 60%); as was five-year OS (I: 49% vs 31%; II: 36% vs 18%). After adjustment for gender, histology, stage, treatment, and comorbidity, hazard ratio (HR) of death was higher for patients aged ≥75 compared to those aged 65-74 (I: HR 1.3, 95% confidence interval (CI) 1.1-1.5; II: HR 1.3 95%CI 1.1-1.7). CONCLUSION: Patients aged ≥75 with stage I-II NSCLC had poorer OS, underwent surgery less often, and received SBRT, conventional RT, and BSC more often than patients aged 65-74. In both stages, one-year OS within age groups was similar for surgery and SBRT. However, long-term OS adjusted for prognostic factors was superior for surgery compared to SBRT and remained poorer for those aged ≥75. Prospective research should focus on predictive characteristics for treatment selection and patient-centered outcomes.
OBJECTIVES: Insights regarding utilization and survival of surgery and radiotherapy (stereotactic body radiotherapy (SBRT) or conventional radiotherapy (RT)) are lacking for older patients with stage I and II non-small cell lung cancer (NSCLC) in clinical practice. METHODS: Data from the Netherlands Cancer Registry were retrieved for patients ≥65 years with clinical stage I-II NSCLC in 2010-2015. Descriptive analyses, overall survival (OS), and cox regression were stratified for stage I (n = 8742) and II (n = 3439) and compared age groups (65-74 years vs ≥75 years). RESULTS:Patients aged 65-74 underwent surgery significantly more often compared to those aged ≥75 (stage I 55% vs 27%; stage II: 65% vs 35%), and received SBRT less often (I: 29% vs 42%; II: 5% vs 11%), conventional RT less often (I: 6% vs 11%; II 10% vs 24%) and best supportive care alone less often (BSC, I: 8% vs 19%; II: 9% vs 25%). One-year OS was significantly higher in patients aged 65-74 compared to those aged ≥75 (I: 87% vs 78%; II: 74% vs 60%); as was five-year OS (I: 49% vs 31%; II: 36% vs 18%). After adjustment for gender, histology, stage, treatment, and comorbidity, hazard ratio (HR) of death was higher for patients aged ≥75 compared to those aged 65-74 (I: HR 1.3, 95% confidence interval (CI) 1.1-1.5; II: HR 1.3 95%CI 1.1-1.7). CONCLUSION:Patients aged ≥75 with stage I-II NSCLC had poorer OS, underwent surgery less often, and received SBRT, conventional RT, and BSC more often than patients aged 65-74. In both stages, one-year OS within age groups was similar for surgery and SBRT. However, long-term OS adjusted for prognostic factors was superior for surgery compared to SBRT and remained poorer for those aged ≥75. Prospective research should focus on predictive characteristics for treatment selection and patient-centered outcomes.
Authors: Rhami Khorfan; Timothy J Kruser; Julia M Coughlin; Ankit Bharat; Karl Y Bilimoria; David D Odell Journal: Ann Thorac Surg Date: 2020-03-05 Impact factor: 4.330
Authors: Sophie Pilleron; Helen Gower; Maryska Janssen-Heijnen; Virginia Claire Signal; Jason K Gurney; Eva Ja Morris; Ruth Cunningham; Diana Sarfati Journal: BMJ Open Date: 2021-03-10 Impact factor: 2.692