Adjuvant chemotherapy following SBRT for early stage non-small cell lung cancer (NSCLC) in older patients

Madison Grinnell, Adams Kusi Appiah, Michael Baine, Vinicius Ernani, Alissa Marr, Chi Zhang, Weining Zhen, Laxmi Narayana R. Buddharaju, Lynette M. Smith, Apar Kishor Ganti

Research output: Contribution to journalArticle

Abstract

Adjuvant chemotherapy improves overall survival (OS) following stereotactic body radiotherapy (SBRT) in patients with early stage non-small cell lung cancer and tumors ≥four cm. Here, we aim to evaluate its role following SBRT in older patients. Patients >70 years diagnosed with clinical stages I-II NSCLC, (N0 disease), who received SBRT, were identified using the National Cancer Database (n = 7042). The Kaplan-Meier method was used to estimate OS, and the log-rank test was used to compare distributions by treatment strategy overall and within clinical stages I and II. There were 3533 female patients (50.2%), and 6074 (86.3%) had stage I disease. Among stage I patients, 643 (10.6%) received adjuvant chemotherapy, compared to 372 stage II patients (38.4%). Median OS was better with SBRT in patients with stage I disease (25.4 vs. 20.3 months; p < .001); while patients with stage II NSCLC had better OS with SBRT + chemotherapy (20.2 vs. 14.2 months; p < .001). On multivariate analysis, patients with stage I NSCLC who received SBRT alone had better overall survival (HR: 0.79; 95% CI, 0.73, 0.87). SBRT alone was associated with an increased risk of death in patients with stage II disease (HR: 1.34; 95% CI, 1.15, 1.55). Patients with tumors ≥4 cm had better OS with SBRT + chemotherapy (18.5 vs. 15.5 months; p = .003), while patients with tumors <4 cm did better with SBRT (median OS of 24.1 vs. 20.3 months; p < .001). In >70 years old patients with tumors ≥4 cm, adjuvant chemotherapy following SBRT was associated with improved OS.

Original languageEnglish (US)
Pages (from-to)1145-1153
Number of pages9
JournalJournal of Geriatric Oncology
Volume11
Issue number7
DOIs
StatePublished - Sep 2020

ASJC Scopus subject areas

  • Oncology
  • Geriatrics and Gerontology

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