Effectiveness of radiation therapy alone for elderly patients with unresected stage III non-small cell lung cancer

Abstract

Purpose Chemoradiotherapy is the standard of care for unresectable stage III non-small cell lung cancer (NSCLC). Elderly patients, who are often considered unfit for combined chemoradiotherapy, frequently receive radiation therapy (RT) alone. Using population-based data, we evaluated the effectiveness and tolerability of lone RT in unresected elderly stage III NSCLC patients. Methods and Materials Using the Surveillance, Epidemiology and End Results (SEER) registry linked to Medicare records we identified 10,376 cases of unresected stage III NSCLC that were not treated with chemotherapy, diagnosed between 1992 and 2007. We used logistic regression to determine propensity scores for RT treatment using patients’ pre-treatment characteristics. We then compared survival of patients who underwent lone RT vs. no treatment using a Cox regression model adjusting for propensity scores. The adjusted odds for toxicity among patients treated with and without RT were also estimated. Results Overall, 6,468 (62%) patients received lone RT. Adjusted analyses showed that RT was associated with improved overall survival in unresected stage III NCSLC (hazard ratio [HR]: 0.76; 95% confidence interval [CI]: 0.74–0.79) after controlling for propensity scores. RT treated patients had an increased adjusted risk of hospitalization for pneumonitis (odds ratio [OR]: 89, 95% CI: 12–636), and esophagitis (OR: 8, 95% CI: 3–21). Conclusions These data suggest that use of RT alone may improve the outcomes of elderly patients with unresected stage III NSCLC. Severe toxicity, however, was considerably higher in the RT treated group. The potential risks and benefits of RT should be carefully discussed with eligible elderly NSCLC patients.

Outcomes of Hypofractionated High-Dose Radiotherapy in Poor-Risk Patients with “Ultracentral” Non–Small Cell Lung Cancer

“…1,2 Many elderly patients are unfit for chemoradiotherapy. Population studies show that high-dose radiotherapy (RT) alone is used in 11% to 41% of elderly patients with stage III NSCLC, whereas 21% to 27% receive no anticancer treatment, [3][4][5] resulting in median overall survival (OS) times of 7.6 and 6.9 months, respectively. [3][4][5] As the requirement for travel for 4-6 weeks to undergo conventional RT may discourage frail patients, 6 shorter hypofractionated RT regimens have been advocated.…”

“…Population studies show that high-dose radiotherapy (RT) alone is used in 11% to 41% of elderly patients with stage III NSCLC, whereas 21% to 27% receive no anticancer treatment, [3][4][5] resulting in median overall survival (OS) times of 7.6 and 6.9 months, respectively. [3][4][5] As the requirement for travel for 4-6 weeks to undergo conventional RT may discourage frail patients, 6 shorter hypofractionated RT regimens have been advocated. 1 Stereotactic ablative RT (SABR) is the current standard of care for unfit patients with peripheral lung cancers and has been defined by delivery of a BED 10 (biologically effective dose with a / b ¼ 10) of at least 100 Gy.…”

Definitive radiotherapy alone over 60 Gy for patients unfit for combined treatment to stage II-III non-small cell lung cancer: retrospective analysis

“…The median OS time was 9.0 months. The survival was better when using high complexity RT, but survival time was not presented separately [ 18 ]. In phase III intergroup study by Radiation Therapy Oncology Group, Eastern Cooperative Oncology Group, and Southwest Oncology Group, median OS of stage III NSCLC patients treated by lone RT was 11.4 months for standard RT arm (60 Gy) and 12 months for hyperfractionated RT arm (69 Gy) [ 19 ].…”

“…But, these results were achieved mostly before modern RT technique era [ 20 ]. In a population-based study of elderly NSCLC patients, improved survival rates were only shown when high complexity RT approaches were used, and not for low complexity RT [ 18 ]. A lot of reports have shown that definitive RT dose over 60 Gy can be tolerated in older patients, as well as younger patients, and our present study result also confirms it.…”

Chemotherapy in elderly patients with nonsmall cell lung cancer

“…Alternatively, sequential administration of chemotherapy followed by radiation can avoid overlapping toxicities which might also help improve tolerability. Although radiation treatment alone likely will have little impact on long-term survival or cure and is also associated with toxicity (i.e., pneumonitis and esophagitis), it has still been shown to improve symptoms and provide some survival benefit in patients that are unfit for chemotherapy [22].…”