Survival Following Sublobar Resection for Early-Stage Non-Small Cell Lung Cancer With or Without Adjuvant External Beam Radiation Therapy

Rineer, Justin; Schreiber, David; Katsoulakis, Evangelia; Nabhani, T.; Han, P.; Lange, Christopher S.; Choi, Kwang Nam; Rotman, Marvin

doi:10.1378/chest.09-0868

Cited by 13 publications

(8 citation statements)

References 30 publications

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“…We also compared the survival after adjustment by age, gender, race, smoking status, therapy, and stage, because these factors may affect survival in patients with early-stage NSCLC [9]. Table S3 shows the associations between the overall or LC specific survival and these prognostic factors.…”

Section: Resultsmentioning

confidence: 99%

Initial Medical Attention on Patients with Early-Stage Non-Small Cell Lung Cancer

et al. 2012

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BackgroundDetection of early stage non-small cell lung cancer (NSCLC) is commonly believed to be incidental. Understanding the reasons that caused initial detection of these patients is important for early diagnosis. However, these reasons are not well studied.MethodsWe retrospectively reviewed medical records of patients diagnosed with stage I or II NSCLC between 2000 and 2009 at UT MD Anderson Cancer Center. Information on suggestive LC-symptoms or other reasons that caused detection were extracted from patients' medical records. We applied univariate and multivariate analyses to evaluate the association of suggestive LC-symptoms with tumor size and patient survival.ResultsOf the 1396 early stage LC patients, 733 (52.5%) presented with suggestive LC-symptoms as chief complaint. 347 (24.9%) and 287 (20.6%) were diagnosed because of regular check-ups and evaluations for other diseases, respectively. The proportion of suggestive LC-symptom-caused detection had a linear relationship with the tumor size (correlation 0.96; with p<.0001). After age, gender, race, smoking status, therapy, and stage adjustment, the symptom-caused detection showed no significant difference in overall and LC-specific survival when compared with the other (non-symptom-caused) detection.ConclusionSymptoms suggestive of LC are the number one reason that led to detection in early NSCLC. They were also associated with tumor size at diagnosis, suggesting early stage LC patients are developing symptoms. Presence of symptoms in early stages did not compromise survival. A symptom-based alerting system or guidelines may be worth of further study to benefit NSCLC high risk individuals.

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Section: Resultsmentioning

confidence: 99%

Initial Medical Attention on Patients with Early-Stage Non-Small Cell Lung Cancer

et al. 2012

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“…However, this potential indication for PORT has not been evaluated in a RCT. A previous study using the SEER database (not linked to Medicare records) examined the effects of PORT after limited resection in localized tumors less than or equal to 7 cm in size (i.e., T1-2, N0, M0 disease) (29). The study found a detrimental effect on overall survival with PORT compared with surgery alone (median survival 32 vs. 44 mo, respectively).…”

Section: Discussionmentioning

confidence: 99%

Adjuvant Treatment for Elderly Patients with Early-Stage Lung Cancer Treated with Limited Resection

Mhango

Bonomi²,

Neugut

et al. 2013

Annals ATS

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Objectives: Limited resection is commonly used for treating older patients with early-stage non-small cell lung cancer (NSCLC) who cannot tolerate lobectomy. However, parenchymal-sparing procedures leave patients at increased risk of recurrence. The role of postoperative radiotherapy (PORT) and chemotherapy after limited resection is not established. Methods:We identified 1,929 patients with stage I-II (<5 cm in size) NSCLC 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).Measurements and Main Results: Overall, 1,656 (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 with limited resection alone, the adjusted odds ratios 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 after limited resection in elderly patients with early-stage NSCLC. Alternative strategies should be explored to improve local control.

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“…In the current study, patients with stage I NSCLC based on the sixth edition of the American Joint Committee on Cancer (AJCC) staging manual6 who were treated with radiotherapy alone and registered in the population‐based Surveillance, Epidemiology, and End Results (SEER) database were retrospectively analyzed to better understand the risk factors affecting their overall survival (OS) and cause‐specific survival (CSS). There have been many SEER studies analyzing survival outcomes after resection of stage I NSCLC,7‐12 although to our knowledge few SEER studies have focused on outcomes after radiotherapy alone. Two recent SEER studies demonstrated a significant benefit of radiotherapy (vs no radiotherapy) among patients with unresected, early stage NSCLC 13, 14.…”

Section: Introductionmentioning

confidence: 99%

Definitive radiotherapy for stage I nonsmall cell lung cancer

Milano

Zhang

Usuki

et al. 2012

Cancer

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BACKGROUND:The current study characterizes the overall survival (OS) and cause-specific survival (CSS) of patients with stage I nonsmall cell lung cancer (NSCLC) who were treated with radiotherapy alone, and analyzes the variables potentially affecting survival outcomes. METHODS: A total of 8524 patients with stage I NSCLC (according to the sixth edition of the American Joint Committee on Cancer staging manual) who were diagnosed between 1988 and 2008 were retrospectively analyzed using the population-based Surveillance, Epidemiology, and End Results database. Cox regression analysis was used to calculate hazard ratios (HR) from multivariate analyses. RESULTS: The 1-year, 2-year, and 5-year OS rates were 62%, 37%, and 11%, respectively; the corresponding lung cancer CSS survival rates were 68%, 45%, and 20%, respectively. Approximately 77% of deaths were from lung cancer (5292 of 6891 total deaths). Cardiac (n ¼ 477 deaths) and pulmonary (other than lung cancer deaths; n ¼ 475 deaths) deaths accounted for 14% of deaths. From Cox proportional hazards analyses, male sex (HR, 1.2) and squamous cell carcinoma histology (HR, > 1.1) were found to be significantly (P < .0001) adverse prognostic factors for both OS and lung cancer CSS. A more recent calendar year of diagnosis was associated with significantly (P < .0001) improved OS (HR, 0.84 per decade) and lung cancer CSS. This trend was also significant (P < 0.0001) when restricting analyses to those patients with tumors measuring 5 cm (n ¼ 5402 patients). T1 classification (vs T2 or T unknown) and smaller tumor size were found to be significantly (P < .0001) favorable factors. CONCLUSIONS: From a population-based registry analysis of patients with stage I NSCLC, significant (albeit modest) improvements in survival in more recent years were appreciated, which likely reflect technologic advances in the diagnosis of, staging of, and radiotherapy for NSCLC. Cancer 2012;118:5572-9.

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Survival Following Sublobar Resection for Early-Stage Non-Small Cell Lung Cancer With or Without Adjuvant External Beam Radiation Therapy

Cited by 13 publications

References 30 publications

Initial Medical Attention on Patients with Early-Stage Non-Small Cell Lung Cancer

Initial Medical Attention on Patients with Early-Stage Non-Small Cell Lung Cancer

Adjuvant Treatment for Elderly Patients with Early-Stage Lung Cancer Treated with Limited Resection

Definitive radiotherapy for stage I nonsmall cell lung cancer

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