Effect of Radiotherapy Planning Complexity on Survival of Elderly Patients With Unresected Localized Lung Cancer

• Published in: International journal of radiation oncology, biology, physics Vol. 81; no. 3; pp. 706 - 711
• Main Authors: Park, Chang H., B.A, Bonomi, Marcelo, M.D, Cesaretti, Jamie, M.D, Neugut, Alfred I., M.D., Ph.D, Wisnivesky, Juan P., M.D., Dr.P.H
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2011; Elsevier
• Subjects: ADULTS; AGE GROUPS; Aged; AGED ADULTS; ANIMALS; Biological and medical sciences; BODY; Carcinoma, Non-Small-Cell Lung - classification; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - radiotherapy; Complexity; DISEASES; ELDERLY PEOPLE; EPIDEMIOLOGY; Female; HAZARDS; Hematology, Oncology and Palliative Medicine; HUMAN POPULATIONS; Humans; International Classification of Diseases; Lung cancer; Lung Neoplasms - classification; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - radiotherapy; LUNGS; Male; MAMMALS; MAN; Matched-Pair Analysis; Medical sciences; Medicare - statistics & numerical data; MEDICINE; MINORITY GROUPS; Neoplasm Staging; NEOPLASMS; NUCLEAR MEDICINE; ORGANS; Pneumology; POPULATIONS; PRIMATES; Proportional Hazards Models; RADIOLOGY; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy, Computer-Assisted - methods; Radiotherapy, Computer-Assisted - mortality; RESPIRATORY SYSTEM; SEER Program; SIMULATION; Survival; Survival Analysis; THERAPY; Tumors of the respiratory system and mediastinum; United States; Unresected; VERTEBRATES; United States; Radiotherapy; Survival; Lung cancer; Unresected; Complexity; Human; Lung disease; Respiratory disease; Malignant tumor; Treatment; Bronchus disease; Elderly; Cancer
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2010.06.060

Purpose To evaluate whether complex radiotherapy (RT) planning was associated with improved outcomes in a cohort of elderly patients with unresected Stage I–II non–small-cell lung cancer (NSCLC). Methods and Materials Using the Surveillance, Epidemiology, and End Results registry linked to Medicare claims, we identified 1998 patients aged >65 years with histologically confirmed, unresected stage I–II NSCLC. Patients were classified into an intermediate or complex RT planning group using Medicare physician codes. To address potential selection bias, we used propensity score modeling. Survival of patients who received intermediate and complex simulation was compared using Cox regression models adjusting for propensity scores and in a stratified and matched analysis according to propensity scores. Results Overall, 25% of patients received complex RT planning. Complex RT planning was associated with better overall (hazard ratio 0.84; 95% confidence interval, 0.75-0.95) and lung cancer–specific (hazard ratio 0.81; 95% confidence interval, 0.71–0.93) survival after controlling for propensity scores. Similarly, stratified and matched analyses showed better overall and lung cancer–specific survival of patients treated with complex RT planning. Conclusions The use of complex RT planning is associated with improved survival among elderly patients with unresected Stage I–II NSCLC. These findings should be validated in prospective randomized controlled trials.