TY - JOUR
T1 - Outcomes Following SBRT vs. IMRT and 3DCRT for Older Patients with Stage IIA Node-Negative Non-Small Cell Lung Cancer > 5 cm
AU - Tran, Jessica H.
AU - Mhango, Grace
AU - Park, Henry S.
AU - Marshall, Deborah C.
AU - Rosenzweig, Kenneth E.
AU - Wang, Qian
AU - Wisnivesky, Juan P.
AU - Veluswamy, Rajwanth R.
N1 - Funding Information:
The authors would like to thank: the Tisch Cancer Institute Summer Scholars Program at Mount Sinai Hospital; the Applied Research Branch, Division of Cancer Prevention and Population Science, National Cancer Institute; the Office of Information Services and the Office of Strategic Planning, Health Care Finance Administration; Information Management Services, Inc.; the SEER Program tumor registries for their efforts in the creation of the SEER-Medicare Database. The collection, interpretation, and reporting of these data are the sole responsibilities of the authors. All significant contributors of this manuscript have been listed. Jessica H. Tran, BS received internal funding from the Tisch Cancer Institute Summer Scholars Program at Mount Sinai Hospital to support this study.
Funding Information:
RRV serves on advisory boards for Bristol-Myers Squibb (BMS), AstraZeneca, Merck and Novocure, on speaker's bureau of AstraZeneca, received consulting honorarium from Onconova Therapeutics, and research grants from BMS, Lung Cancer Research Foundation and AstraZeneca. JPW received consulting honorarium from Banook, Atea, PPD, and Sanofi and research grants from Sanofi, Regeneron and Arnold Consulting. HSP serves on an advisory board for Galera Therapeutics, received honorarium from BMS, Guidepoint, Grand Rounds Health, Healthcasts, Healthline and RadOncQuestions, consulting fees from AstraZeneca, speaking fees from BMS and research grants from RefleXion Medical and U.S. FDA. DM receives a research grant from the NIH T32 program. JHT, GM, QW, and KR have no conflicts of interest to declare.
Funding Information:
Jessica H. Tran, BS received internal funding from the Tisch Cancer Institute Summer Scholars Program at Mount Sinai Hospital to support this study.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2023/1
Y1 - 2023/1
N2 - Background: To describe outcomes and compare the effectiveness of stereotactic body radiotherapy (SBRT) versus 3-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT) in patients with stage IIA lymph node-negative (N0) non-small cell lung cancer (NSCLC) tumors > 5 cm. Methods: We used the SEER-Medicare database (2005-2015) to identify patients > 65 years with stage IIA (AJCC TNM7) N0 NSCLC > 5 cm tumors who were treated with SBRT, IMRT, and 3DCRT. We used propensity score methods with inverse probability weighting to compare lung cancer-specific survival (LCSS), overall survival (OS), and toxicity. Results: Of 584 patients, 88 (15%), 140 (24%), and 356 (61%) underwent SBRT, IMRT, and 3DCRT, respectively. The SBRT group was older (P = .004), had more comorbidities (P = .02), smaller tumors (P = .03), and more adenocarcinomas (P < .0001). We found a trend towards higher median unadjusted OS with SBRT compared to IMRT and 3DCRT (19 vs. 13 and 14 months, respectively, P = .37). In our propensity score-adjusted analyses, SBRT was significantly associated with better OS and LCSS compared to IMRT (HROS: 0.78, 95% CI: 0.68-0.89, HRLCSS: 0.70, 95% CI: 0.60-0.81) and 3DCRT (HROS: 0.81, 95% CI: 0.72-0.93, HRLCSS: 0.80, 95% CI: 0.68-0.93). SBRT-treated patients also had lower overall adjusted complication rates compared to IMRT (OR: 0.74, 95% CI: 0.55-0.99) and 3DCRT (OR: 0.53, 95% CI: 0.40-0.71). Conclusion: For patients with NSCLC tumors > 5 cm, SBRT trends towards fewer toxicities and improved survival compared to other forms of radiotherapy. Our findings support SBRT as an appropriate treatment strategy for older patients with larger inoperable NSCLC tumors.
AB - Background: To describe outcomes and compare the effectiveness of stereotactic body radiotherapy (SBRT) versus 3-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT) in patients with stage IIA lymph node-negative (N0) non-small cell lung cancer (NSCLC) tumors > 5 cm. Methods: We used the SEER-Medicare database (2005-2015) to identify patients > 65 years with stage IIA (AJCC TNM7) N0 NSCLC > 5 cm tumors who were treated with SBRT, IMRT, and 3DCRT. We used propensity score methods with inverse probability weighting to compare lung cancer-specific survival (LCSS), overall survival (OS), and toxicity. Results: Of 584 patients, 88 (15%), 140 (24%), and 356 (61%) underwent SBRT, IMRT, and 3DCRT, respectively. The SBRT group was older (P = .004), had more comorbidities (P = .02), smaller tumors (P = .03), and more adenocarcinomas (P < .0001). We found a trend towards higher median unadjusted OS with SBRT compared to IMRT and 3DCRT (19 vs. 13 and 14 months, respectively, P = .37). In our propensity score-adjusted analyses, SBRT was significantly associated with better OS and LCSS compared to IMRT (HROS: 0.78, 95% CI: 0.68-0.89, HRLCSS: 0.70, 95% CI: 0.60-0.81) and 3DCRT (HROS: 0.81, 95% CI: 0.72-0.93, HRLCSS: 0.80, 95% CI: 0.68-0.93). SBRT-treated patients also had lower overall adjusted complication rates compared to IMRT (OR: 0.74, 95% CI: 0.55-0.99) and 3DCRT (OR: 0.53, 95% CI: 0.40-0.71). Conclusion: For patients with NSCLC tumors > 5 cm, SBRT trends towards fewer toxicities and improved survival compared to other forms of radiotherapy. Our findings support SBRT as an appropriate treatment strategy for older patients with larger inoperable NSCLC tumors.
KW - Early-stage
KW - Medicare
KW - NSCLC
KW - Older Adults
KW - Radiotherapy
UR - http://www.scopus.com/inward/record.url?scp=85143623926&partnerID=8YFLogxK
U2 - 10.1016/j.cllc.2022.10.006
DO - 10.1016/j.cllc.2022.10.006
M3 - Article
C2 - 36443153
AN - SCOPUS:85143623926
SN - 1525-7304
VL - 24
SP - e9-e18
JO - Clinical Lung Cancer
JF - Clinical Lung Cancer
IS - 1
ER -