title: Outcomes after adjuvant platinum-based chemotherapy in elderly NSCLC patients with T4 disease.
abstract: BACKGROUND
  The postoperative management of elderly patients with T4, N0-1, M0 non-small cell lung cancer (NSCLC) remains controversial. The objective of this study was to evaluate the association of adjuvant chemotherapy with survival and toxicity among these patients.
  
  
  METHODS
  Using surveillance, epidemiology and end results registry data linked to Medicare claims, we identified 389 elderly patients with resected T4, N0-1, M0 NSCLC diagnosed between 1992 and 2007. We compared survival of patients treated with and without platinum-based chemotherapy using a Cox regression adjusting for propensity scores for chemotherapy use and use of radiotherapy. We used logistic regression to assess the risk of adverse events in patients receiving chemotherapy.
  
  
  RESULTS
  No benefit was noted in overall survival with adjuvant chemotherapy after PS adjustment for both N0 (hazard ratio 0.78, 95% confidence interval 0.50-1.23) and N1 (hazard ratio 1.01, 95% confidence interval 0.67-1.53) cancers. Patients receiving adjuvant chemotherapy experienced severe adverse events more frequently than patients who did not receive chemotherapy.
  
  
  CONCLUSIONS
  Use of adjuvant chemotherapy in elderly patients with T4, N0-1, M0 NSCLC was not associated with a survival advantage and was associated with higher rates of severe toxicity.
authors.affiliation: Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY, USA. Keith.Sigel@mssm.edu
authors.forename: Keith
authors.initials: K
authors.lastname: Sigel
authors.forename: Grace
authors.initials: G
authors.lastname: Mhango
authors.forename: Jessica
authors.initials: J
authors.lastname: Cohen
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Halm
authors.forename: John
authors.initials: J
authors.lastname: Mandeli
authors.forename: Gary
authors.initials: G
authors.lastname: Strauss
authors.forename: Juan
authors.initials: J
authors.lastname: Wisnivesky
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D000368:Aged; D018287:Carcinoma, Large Cell / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D009367:Neoplasm Staging; D010984:Platinum / Q000627:therapeutic use*; D011379:Prognosis; D018426:SEER Program; D015996:Survival Rate
chemical_list: D010984:Platinum