title: Cisplatin vs. carboplatin-based chemoradiotherapy in patients >65 years of age with stage III non-small cell lung cancer.
abstract: OBJECTIVE
  Combined chemoradiotherapy (CRT) is considered the standard care for unresectable stage III non-small cell lung cancer (NSCLC). There have been limited data comparing outcomes of carboplatin vs. cisplatin-based CRT, particularly in elderly.
  
  
  METHODS
  From the Surveillance, Epidemiology and End Results-Medicare registry, we identified 1878 patients >65 years of age with unresected stage III NSCLC that received concurrent CRT between 2002 and 2009. We fitted a propensity score model predicting use of cisplatin-based therapy and compared adjusted overall and lung-cancer specific survival of carboplatin- vs. cisplatin-treated patients. Rates of severe toxicity requiring hospital admission were compared in propensity score adjusted analyses.
  
  
  RESULTS
  Overall 1552 (83%) received carboplatin (77% in combination with paclitaxel) and 17% cisplatin (67% in combination with etoposide). Adjusted cox models showed similar overall (hazard ratio [HR]: 0.98; 95% confidence interval [CI]: 0.86-1.12) and lung cancer-specific (HR: 0.99; 95% CI: 0.84-1.17) survival among patients treated with carboplatin vs. cisplatin. Adjusted rates of neutropenia (odds ratio [OR]: 0.35; 95% CI: 0.21-0.61), anemia (OR: 0.67; 95% CI: 0.51-0.89), and thrombocytopenia (OR: 0.51; 95% CI: 0.31-0.85) were lower among carboplatin-treated patients; other toxicities were not different between groups.
  
  
  CONCLUSIONS
  Carboplatin-based CRT is associated with similar long-term survival but lower rates of toxicity. These findings suggest carboplatin may be the most appropriate chemotherapeutic agent for elderly stage III patients.
authors.affiliation: Department of Medicine, Respiratory Division and Respiratory Epidemiology and Clinical Research Unit, McGill University, Montreal, Canada; Divisions of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, United States. Electronic address: nicole.ezer@mountsinai.org.
authors.forename: Nicole
authors.initials: N
authors.lastname: Ezer
authors.affiliation: Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, United States; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, United States.
authors.forename: Cardinale B
authors.initials: CB
authors.lastname: Smith
authors.affiliation: Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, United States.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Galsky
authors.affiliation: Divisions of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, United States.
authors.forename: Grace
authors.initials: G
authors.lastname: Mhango
authors.affiliation: Department of Medicine, UMass Memorial Medical Center, United States.
authors.forename: Fei
authors.initials: F
authors.lastname: Gu
authors.affiliation: Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, United States.
authors.forename: Jorge
authors.initials: J
authors.lastname: Gomez
authors.affiliation: Department of Medicine, Tufts University School of Medicine, Boston, United States; Division of Hematology-Oncology, Tufts Medical Center, Boston, United States.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Strauss
authors.affiliation: Divisions of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, United States; Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, United States.
authors.forename: Juan
authors.initials: J
authors.lastname: Wisnivesky
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D059248:Chemoradiotherapy / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D018426:SEER Program; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
chemical_list: D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin
keywords: Carboplatin; Chemoradiotherapy; Cisplatin; Elderly; Non small cell lung cancer