title: Adjuvant treatment for elderly patients with early-stage lung cancer treated with limited resection.
abstract: OBJECTIVE
  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).
  
  
  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.
authors.affiliation: 1 Division of General Internal Medicine.
authors.forename: Rajwanth R
authors.initials: RR
authors.lastname: Veluswamy
authors.forename: Grace
authors.initials: G
authors.lastname: Mhango
authors.forename: Marcelo
authors.initials: M
authors.lastname: Bonomi
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
authors.forename: Melissa D
authors.initials: MD
authors.lastname: Aldridge
authors.forename: Juan P
authors.initials: JP
authors.lastname: Wisnivesky
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D018287:Carcinoma, Large Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D006278:Medicare; D009367:Neoplasm Staging; D016017:Odds Ratio; D011013:Pneumonectomy; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States
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