Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2012 Dec 1;84(5):1060-70.
doi: 10.1016/j.ijrobp.2012.07.2354. Epub 2012 Sep 11.

Comparative effectiveness of 5 treatment strategies for early-stage non-small cell lung cancer in the elderly

Shervin M Shirvani  1 , Jing Jiang, Joe Y Chang, James W Welsh, Daniel R Gomez, Stephen Swisher, Thomas A Buchholz, Benjamin D Smith
Affiliations
Comparative Study

Comparative effectiveness of 5 treatment strategies for early-stage non-small cell lung cancer in the elderly

Shervin M Shirvani et al. Int J Radiat Oncol Biol Phys. .

Abstract

Purpose: The incidence of early-stage non-small cell lung cancer (NSCLC) among older adults is expected to increase because of demographic trends and computed tomography-based screening; yet, optimal treatment in the elderly remains controversial. Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare cohort spanning 2001-2007, we compared survival outcomes associated with 5 strategies used in contemporary practice: lobectomy, sublobar resection, conventional radiation therapy, stereotactic ablative radiation therapy (SABR), and observation.

Methods and materials: Treatment strategy and covariates were determined in 10,923 patients aged ≥ 66 years with stage IA-IB NSCLC. Cox regression, adjusted for patient and tumor factors, compared overall and disease-specific survival for the 5 strategies. In a second exploratory analysis, propensity-score matching was used for comparison of SABR with other options.

Results: The median age was 75 years, and 29% had moderate to severe comorbidities. Treatment distribution was lobectomy (59%), sublobar resection (11.7%), conventional radiation (14.8%), observation (12.6%), and SABR (1.1%). In Cox regression analysis with a median follow-up time of 3.2 years, SABR was associated with the lowest risk of death within 6 months of diagnosis (hazard ratio [HR] 0.48; 95% confidence interval [CI] 0.38-0.63; referent is lobectomy). After 6 months, lobectomy was associated with the best overall and disease-specific survival. In the propensity-score matched analysis, survival after SABR was similar to that after lobectomy (HR 0.71; 95% CI 0.45-1.12; referent is SABR). Conventional radiation and observation were associated with poor outcomes in all analyses.

Conclusions: In this population-based experience, lobectomy was associated with the best long-term outcomes in fit elderly patients with early-stage NSCLC. Exploratory analysis of SABR early adopters suggests efficacy comparable with that of surgery in select populations. Evaluation of these therapies in randomized trials is urgently needed.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: A portion of this study was funded by a research grant from Varian Medical Systems (SR2011-00034954RG 01). This entity had no role in the study design, data analysis, or data interpretation. Dr. Welsh reports a compensated consultory role to Reflexion Medical. Other conflicts of interest: None

Figures

Figure 1
Figure 1
Unadjusted Kaplan Meier curves for (A) overall survival and (B) lung cancer-specific survival stratified by treatment type.
Figure 2
Figure 2
Overall survival and lung cancer-specific survival for propensity matched SABR cases and non-SABR cohorts.
See this image and copyright information in PMC

Comment in

References

    1. Rami-Porta R, Crowley JJ, Goldstraw P. The revised TNM staging system for lung cancer. Ann Thorac Cardiovasc Surg. 2009;15:4–9. - PubMed
    1. Smith BD, Smith GL, Hurria A, et al. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol. 2009;27:2758–2765. - PubMed
    1. Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365:395–409. - PMC - PubMed
    1. Warren JL, Klabunde CN, Schrag D, et al. Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care. 2002;40:IV-3–18. - PubMed
    1. Doria-Rose VP, Marcus PM. Death certificates provide an adequate source of cause of death information when evaluating lung cancer mortality: an example from the Mayo Lung Project. Lung Cancer. 2009;63:295–300. - PMC - PubMed

Publication types

MeSH terms