Authors: Veluswamy RR, Mhango G, Bonomi M, Neugut AI, Hershman DL, Aldridge MD, Wisnivesky JP
Title: Adjuvant Treatment for Elderly Patients with Early Stage Lung Cancer Treated with Limited Resection.
Journal: Ann Am Thorac Soc :-
Date: 2013 Sep 11
Abstract: Objectives: Limited resection is commonly used for treating older, early stage non-small cell lung cancer (NSCLC) patients who cannot tolerate lobectomy. However, parenchymal-sparing procedures leave patients at increased risk of recurrence. The role of postoperative radiotherapy (PORT) and chemotherapy following limited resection is not established. Methods: We identified 1,929 stage I-II (≤5 cm in size) NSCLC patients 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). Results: Overall, 1656 (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 to limited resection alone, the adjusted odds ratio 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 following limited resection in elderly patients with early stage NSCLC. Alternative strategies should be explored to improve local control.
Last Modified: 03 Sep 2013