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Comparative Study
. 2010 Feb 1;181(3):264-9.
doi: 10.1164/rccm.200907-1064OC. Epub 2009 Nov 5.

Effectiveness of radiation therapy for elderly patients with unresected stage I and II non-small cell lung cancer

Juan P Wisnivesky  1 , Ethan Halm, Marcelo Bonomi, Charles Powell, Emilia Bagiella
Affiliations
Comparative Study

Effectiveness of radiation therapy for elderly patients with unresected stage I and II non-small cell lung cancer

Juan P Wisnivesky et al. Am J Respir Crit Care Med. .

Abstract

Rationale: Radiotherapy (RT) is considered the standard treatment for patients with stage I or II non-small lung cancer who are not surgical candidates because of comorbities or preferences against surgery.

Objectives: To compare the outcomes of patients treated with RT alone with those who were untreated to assess the effect of RT on survival.

Methods: Using the Surveillance, Epidemiology and End Results (SEER) registry linked to Medicare files, we identified 6,065 unresected patients with histologically confirmed stage I and stage II non-small cell lung cancer, diagnosed between 1992 and 2002. We used propensity score methods and instrumental variable analysis to control for the possible effects of known as well as unmeasured confounders.

Measurements and main results: Overall, 59% of patients received RT. The overall and lung cancer-specific survival of unresected patients treated with RT was significantly better compared with the untreated cases (P < 0.0001 for both comparisons). RT was associated with a 6-month improvement in median overall survival. Propensity score analyses showed that RT was associated with improved overall (hazard ratio, 0.74; 95% confidence interval, 0.70-0.78) and lung cancer-specific survival (hazard ratio, 0.73; 95% confidence interval, 0.69-0.78). Instrumental variable analysis also indicated improved outcomes among patients treated with RT.

Conclusions: RT improves survival of elderly patients with unresected stage I or II lung cancer. These results should be confirmed in prospective trials.

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Figures

Figure 1.
Figure 1.
(A) Unadjusted overall survival of elderly patients with unresected stage I and II NSCLC according to whether they were treated with radiotherapy (RT). Overall survival was significantly better among patients treated with RT (P < 0.0001). (B) Unadjusted lung cancer-specific survival of elderly patients with unresected stage I and II NSCLC treated with and without RT. Patients treated with RT had significantly better lung cancer specific survival compared with those who were not treated (P < 0.0001).
Figure 1.
Figure 1.
(A) Unadjusted overall survival of elderly patients with unresected stage I and II NSCLC according to whether they were treated with radiotherapy (RT). Overall survival was significantly better among patients treated with RT (P < 0.0001). (B) Unadjusted lung cancer-specific survival of elderly patients with unresected stage I and II NSCLC treated with and without RT. Patients treated with RT had significantly better lung cancer specific survival compared with those who were not treated (P < 0.0001).
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