title: Effectiveness of radiation therapy alone for elderly patients with unresected stage III non-small cell lung cancer.
abstract: OBJECTIVE
  Chemoradiotherapy is the standard of care for unresectable stage III non-small cell lung cancer (NSCLC). Elderly patients, who are often considered unfit for combined chemoradiotherapy, frequently receive radiation therapy (RT) alone. Using population-based data, we evaluated the effectiveness and tolerability of lone RT in unresected elderly stage III NSCLC patients.
  
  
  METHODS
  Using the Surveillance, Epidemiology and End Results (SEER) registry linked to Medicare records we identified 10,376 cases of unresected stage III NSCLC that were not treated with chemotherapy, diagnosed between 1992 and 2007. We used logistic regression to determine propensity scores for RT treatment using patients' pre-treatment characteristics. We then compared survival of patients who underwent lone RT vs. no treatment using a Cox regression model adjusting for propensity scores. The adjusted odds for toxicity among patients treated with and without RT were also estimated.
  
  
  RESULTS
  Overall, 6468 (62%) patients received lone RT. Adjusted analyses showed that RT was associated with improved overall survival in unresected stage III NCSLC (hazard ratio [HR]: 0.76; 95% confidence interval [CI]: 0.74-0.79) after controlling for propensity scores. RT treated patients had an increased adjusted risk of hospitalization for pneumonitis (odds ratio [OR]: 89, 95% CI: 12-636), and esophagitis (OR: 8, 95% CI: 3-21).
  
  
  CONCLUSIONS
  These data suggest that use of RT alone may improve the outcomes of elderly patients with unresected stage III NSCLC. Severe toxicity, however, was considerably higher in the RT treated group. The potential risks and benefits of RT should be carefully discussed with eligible elderly NSCLC patients.
authors.affiliation: Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY, United States. Electronic address: Keith.Sigel@mssm.edu.
authors.forename: Keith
authors.initials: K
authors.lastname: Sigel
authors.forename: Linda
authors.initials: L
authors.lastname: Lurslurchachai
authors.forename: Marcelo
authors.initials: M
authors.lastname: Bonomi
authors.forename: Grace
authors.initials: G
authors.lastname: Mhango
authors.forename: Cara
authors.initials: C
authors.lastname: Bergamo
authors.forename: Minal
authors.initials: M
authors.lastname: Kale
authors.forename: Ethan
authors.initials: E
authors.lastname: Halm
authors.forename: Juan
authors.initials: J
authors.lastname: Wisnivesky
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018426:SEER Program; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: CI; CPT; Current Procedural Terminology; Elderly; HR; Lone radiotherapy; NSCLC; Non-small cell lung cancer; OR; OS; Outcomes; PET; RCT; RT; Radiotherapy; SEER; Surveillance, Epidemiology and End Results; Toxicity; Unresectable lung cancer; confidence interval; hazard ratio; non-small cell lung cancer; odds ratio; overall survival; positron emission tomography; radiotherapy; randomized controlled trial