Angel Qin1, Elizabeth Lusk2, Stephanie Daignault-Newton2, Bryan J Schneider2. 1. Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI. Electronic address: qina@med.umich.edu. 2. Center for Cancer Biostatistics, Analytics, and Bioinformatics, School of Public Health, University of Michigan, Ann Arbor, MI.
Abstract
BACKGROUND: Standard treatment for stage III non-small-cell lung cancer (NSCLC) is concurrent chemotherapy and radiation (chemo-RT). However, N3 stage IIIB disease portends a worse prognosis and the tolerability of chemo-RT in patients ≥70 years old is a concern. In this analysis, we evaluate the survival of patients with N3 stage IIIB NSCLC who were treated with chemo-RT or chemotherapy alone with a focus on elderly patients. PATIENTS AND METHODS: We retrospectively analyzed patients diagnosed with N3 stage IIIB NSCLC between 2010 and 2013 using the National Cancer Database. We compared overall survival (OS) between patients who underwent chemo-RT versus chemotherapy alone. The Kaplan-Meier method was used for median OS with log rank tests. Multivariable Cox models were used for multivariable and subgroup analyses. RESULTS: We included 9769 patients in our analysis, 7770 of whom received chemo-RT and 1999 who received chemotherapy alone. The median OS for patients who received chemo-RT was 16.4 months versus 12.7 months with chemotherapy alone (P < .0001). The median OS for patients ≥70 years old who received chemo-RT was 15.0 months versus 12.4 months with chemotherapy alone (P < .0001). In multivariable analyses, the benefit of chemo-RT was similar regardless of age. Subgroup analyses in patients ≥70 years indicated a benefit of chemo-RT (hazard ratio, <1.0) across all patient and disease strata. CONCLUSION: Survival was improved in elderly patients who received chemo-RT versus chemotherapy alone for N3 stage IIIB NSCLC. Our findings suggest that age and comorbidities should not preclude clinicians from recommending chemo-RT to these patients.
BACKGROUND: Standard treatment for stage III non-small-cell lung cancer (NSCLC) is concurrent chemotherapy and radiation (chemo-RT). However, N3 stage IIIB disease portends a worse prognosis and the tolerability of chemo-RT in patients ≥70 years old is a concern. In this analysis, we evaluate the survival of patients with N3 stage IIIB NSCLC who were treated with chemo-RT or chemotherapy alone with a focus on elderly patients. PATIENTS AND METHODS: We retrospectively analyzed patients diagnosed with N3 stage IIIB NSCLC between 2010 and 2013 using the National Cancer Database. We compared overall survival (OS) between patients who underwent chemo-RT versus chemotherapy alone. The Kaplan-Meier method was used for median OS with log rank tests. Multivariable Cox models were used for multivariable and subgroup analyses. RESULTS: We included 9769 patients in our analysis, 7770 of whom received chemo-RT and 1999 who received chemotherapy alone. The median OS for patients who received chemo-RT was 16.4 months versus 12.7 months with chemotherapy alone (P < .0001). The median OS for patients ≥70 years old who received chemo-RT was 15.0 months versus 12.4 months with chemotherapy alone (P < .0001). In multivariable analyses, the benefit of chemo-RT was similar regardless of age. Subgroup analyses in patients ≥70 years indicated a benefit of chemo-RT (hazard ratio, <1.0) across all patient and disease strata. CONCLUSION: Survival was improved in elderly patients who received chemo-RT versus chemotherapy alone for N3 stage IIIB NSCLC. Our findings suggest that age and comorbidities should not preclude clinicians from recommending chemo-RT to these patients.
Authors: Daniel J Boffa; Joshua E Rosen; Katherine Mallin; Ashley Loomis; Greer Gay; Bryan Palis; Kathleen Thoburn; Donna Gress; Daniel P McKellar; Lawrence N Shulman; Matthew A Facktor; David P Winchester Journal: JAMA Oncol Date: 2017-12-01 Impact factor: 31.777
Authors: Thomas E Stinchcombe; Ying Zhang; Everett E Vokes; Joan H Schiller; Jeffrey D Bradley; Karen Kelly; Walter J Curran; Steven E Schild; Benjamin Movsas; Gerald Clamon; Ramaswamy Govindan; George R Blumenschein; Mark A Socinski; Neal E Ready; Wallace L Akerley; Harvey J Cohen; Herbert H Pang; Xiaofei Wang Journal: J Clin Oncol Date: 2017-05-11 Impact factor: 44.544
Authors: Filip Kaniski; Lindsey Enewold; Anish Thomas; Shakuntala Malik; Jennifer L Stevens; Linda C Harlan Journal: Lung Cancer Date: 2016-11-29 Impact factor: 5.705
Authors: Matthew J Bott; Aalok P Patel; Traves D Crabtree; Daniel Morgensztern; Clifford G Robinson; Graham A Colditz; Saiama Waqar; Daniel Kreisel; A Sasha Krupnicka; G Alexander Patterson; Stephen Broderick; Bryan F Meyers; Varun Puri Journal: Ann Thorac Surg Date: 2015-04-23 Impact factor: 4.330
Authors: David S Ettinger; Douglas E Wood; Wallace Akerley; Lyudmila A Bazhenova; Hossein Borghaei; David Ross Camidge; Richard T Cheney; Lucian R Chirieac; Thomas A D'Amico; Thomas J Dilling; M Chris Dobelbower; Ramaswamy Govindan; Mark Hennon; Leora Horn; Thierry M Jahan; Ritsuko Komaki; Rudy P Lackner; Michael Lanuti; Rogerio Lilenbaum; Jules Lin; Billy W Loo; Renato Martins; Gregory A Otterson; Jyoti D Patel; Katherine M Pisters; Karen Reckamp; Gregory J Riely; Steven E Schild; Theresa A Shapiro; Neelesh Sharma; James Stevenson; Scott J Swanson; Kurt Tauer; Stephen C Yang; Kristina Gregory; Miranda Hughes Journal: J Natl Compr Canc Netw Date: 2016-03 Impact factor: 11.908
Authors: Kent Russell; Brian Healy; Jason Pantarotto; Scott A Laurie; Robert MacRae; Elham Sabri; Paul Wheatley-Price Journal: Clin Lung Cancer Date: 2013-12-27 Impact factor: 4.785