Adjuvant Treatment for Elderly Patients with Early-Stage Lung Cancer Treated with Limited Resection

Abstract

Objectives: Limited resection is commonly used for treating older patients with early-stage non-small cell lung cancer (NSCLC) who cannot tolerate lobectomy. However, parenchymal-sparing procedures leave patients at increased risk of recurrence. The role of postoperative radiotherapy (PORT) and chemotherapy after limited resection is not established. Methods:We identified 1,929 patients with stage I-II (<5 cm in size) NSCLC who underwent limited resection (wedge or segmentectomy) from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Using propensity score methods, we compared toxicity and survival of patients treated with limited resection alone, PORT, adjuvant chemotherapy, or PORT and chemotherapy. We conducted secondary analysis stratifying the sample by size (.2-5 cm), stage (IA vs. IB/IIA), and type of limited resection (wedge resection vs. segmentectomy).Measurements and Main Results: Overall, 1,656 (85.8%), 159 (8.3%), 74 (3.8%), and 40 (2.1%) patients were treated with limited resection alone, PORT, adjuvant chemotherapy, or PORT and chemotherapy, respectively. Adjusted analysis using inverse probability weighting showed that PORT (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.45-1.69), adjuvant chemotherapy (HR, 1.48; 95% CI, 1.36-1.61), and PORT and chemotherapy (HR, 1.73; 95% CI, 1.61-1.86) were associated with worse survival compared with limited resection alone. Similar results were obtained in secondary analyses. Compared with limited resection alone, the adjusted odds ratios for toxicity were 1.97 (95% CI, 1.6-2.4), 3.15 (95% CI, 2.58-3.85), 2.59 (95% CI, 2.0-3.4) for PORT, chemotherapy, and PORT and chemotherapy, respectively.Conclusions: PORT and adjuvant chemotherapy are not beneficial and appear to be associated with increased toxicity and worse survival after limited resection in elderly patients with early-stage NSCLC. Alternative strategies should be explored to improve local control.

Association of Survival With Adjuvant Chemotherapy Among Patients With Early-Stage Non–Small Cell Lung Cancer With vs Without High-Risk Clinicopathologic Features

“…More specifically, identifying a survival benefit associated with sublobar resection that is not associated with lobectomy could be the consequence of incomplete tumor removal or nodal evaluation . In other words, the chemotherapy could be mitigating a cancer risk that lobectomy alleviates (ie, chemotherapy is not needed), but sublobar resection does not . This finding would support earlier studies that suggest that lobectomy is the preferred approach for early-stage lung cancer .…”

Adjuvant chemotherapy may improve long-term outcomes in stage IB non-small cell lung cancer patients with previous malignancies: A propensity score-matched analysis

“…A previous study suggested that chemotherapy could remove the residual cancer risk after sublobar resection (including wedge resection and segmentectomy) ( 22 ). However, neither sublobar resection nor lobectomy was related to chemotherapy benefit in our study; this concurs with the findings of a previous study ( 23 ). A survey indicated that inadequate lymph node sampling may lead to incorrect stage evaluation and chemotherapy could eliminate the cancer risk for these patients ( 24 , 25 ).…”

Risk factors for malignancy-unrelated long-term respiratory events after pneumonectomy

“…[13] In contrast, our results showed lower long-term respiratory morbidity in patients who received adjuvant radiotherapy. This discrepancy can be explained in two ways: first, toxic effects of the radiotherapy were not seen, as there was no lung tissue at the target area of radiotherapy; second, patients with a poor general condition did not receive radiotherapy in our series to prevent possible side effects.…”