title: Cisplatin and etoposide versus carboplatin and paclitaxel with concurrent radiotherapy for stage III non-small-cell lung cancer: an analysis of Veterans Health Administration data.
abstract: OBJECTIVE
  The optimal chemotherapy regimen to use with radiotherapy in stage III non-small-cell lung cancer is unknown. Here, we compare the outcome of patents treated within the Veterans Health Administration with either etoposide-cisplatin (EP) or carboplatin-paclitaxel (CP).
  
  
  METHODS
  We identified patients treated with EP and CP with concurrent radiotherapy from 2001 to 2010. Survival rates were compared using Cox proportional hazards regression models with adjustments for confounding provided by propensity score methods and an instrumental variables analysis. Comorbidities and treatment complications were identified through administrative data.
  
  
  RESULTS
  A total of 1,842 patients were included; EP was used in 27% (n = 499). Treatment with EP was not associated with a survival advantage in a Cox proportional hazards model (hazard ratio [HR], 0.97; 95% CI, 0.85 to 1.10), a propensity score matched cohort (HR, 1.07; 95% CI, 0.91 to 1.24), or a propensity score adjusted model (HR, 0.97; 95% CI, 0.85 to 1.10). In an instrumental variables analysis, there was no survival advantage for patients treated in centers where EP was used more than 50% of the time as compared with centers where EP was used in less than 10% of the patients (HR, 1.07; 95% CI, 0.90 to 1.26). Patients treated with EP, compared with patients treated with CP, had more hospitalizations (2.4 v 1.7 hospitalizations, respectively; P < .001), outpatient visits (17.6 v 12.6 visits, respectively; P < .001), infectious complications (47.3% v 39.4%, respectively; P = .0022), acute kidney disease/dehydration (30.5% v 21.2%, respectively; P < .001), and mucositis/esophagitis (18.6% v 14.4%, respectively; P = .0246).
  
  
  CONCLUSIONS
  After accounting for prognostic variables, patients treated with EP versus CP had similar overall survival, but EP was associated with increased morbidity.
authors.affiliation: Rafael Santana-Davila, University of Washington, Seattle, WA; Kiran Devisetty, Michigan State University, Flint, MI; Aniko Szabo and Rodney Sparapani, Medical College of Wisconsin; Rafael Santana-Davila, Carlos Arce-Lara, Elizabeth M. Gore, Amy Moran, and Jeffrey Whittle, Clement J. Zablocki Veterans Affairs (VA) Medical Center, Milwaukee, WI; and Christina D. Williams and Michael J. Kelley, Durham VA Medical Center, Durham, NC. rafaelsd@u.washington.edu.
authors.forename: Rafael
authors.initials: R
authors.lastname: Santana-Davila
authors.affiliation: Rafael Santana-Davila, University of Washington, Seattle, WA; Kiran Devisetty, Michigan State University, Flint, MI; Aniko Szabo and Rodney Sparapani, Medical College of Wisconsin; Rafael Santana-Davila, Carlos Arce-Lara, Elizabeth M. Gore, Amy Moran, and Jeffrey Whittle, Clement J. Zablocki Veterans Affairs (VA) Medical Center, Milwaukee, WI; and Christina D. Williams and Michael J. Kelley, Durham VA Medical Center, Durham, NC.
authors.forename: Kiran
authors.initials: K
authors.lastname: Devisetty
authors.affiliation: Rafael Santana-Davila, University of Washington, Seattle, WA; Kiran Devisetty, Michigan State University, Flint, MI; Aniko Szabo and Rodney Sparapani, Medical College of Wisconsin; Rafael Santana-Davila, Carlos Arce-Lara, Elizabeth M. Gore, Amy Moran, and Jeffrey Whittle, Clement J. Zablocki Veterans Affairs (VA) Medical Center, Milwaukee, WI; and Christina D. Williams and Michael J. Kelley, Durham VA Medical Center, Durham, NC.
authors.forename: Aniko
authors.initials: A
authors.lastname: Szabo
authors.affiliation: Rafael Santana-Davila, University of Washington, Seattle, WA; Kiran Devisetty, Michigan State University, Flint, MI; Aniko Szabo and Rodney Sparapani, Medical College of Wisconsin; Rafael Santana-Davila, Carlos Arce-Lara, Elizabeth M. Gore, Amy Moran, and Jeffrey Whittle, Clement J. Zablocki Veterans Affairs (VA) Medical Center, Milwaukee, WI; and Christina D. Williams and Michael J. Kelley, Durham VA Medical Center, Durham, NC.
authors.forename: Rodney
authors.initials: R
authors.lastname: Sparapani
authors.affiliation: Rafael Santana-Davila, University of Washington, Seattle, WA; Kiran Devisetty, Michigan State University, Flint, MI; Aniko Szabo and Rodney Sparapani, Medical College of Wisconsin; Rafael Santana-Davila, Carlos Arce-Lara, Elizabeth M. Gore, Amy Moran, and Jeffrey Whittle, Clement J. Zablocki Veterans Affairs (VA) Medical Center, Milwaukee, WI; and Christina D. Williams and Michael J. Kelley, Durham VA Medical Center, Durham, NC.
authors.forename: Carlos
authors.initials: C
authors.lastname: Arce-Lara
authors.affiliation: Rafael Santana-Davila, University of Washington, Seattle, WA; Kiran Devisetty, Michigan State University, Flint, MI; Aniko Szabo and Rodney Sparapani, Medical College of Wisconsin; Rafael Santana-Davila, Carlos Arce-Lara, Elizabeth M. Gore, Amy Moran, and Jeffrey Whittle, Clement J. Zablocki Veterans Affairs (VA) Medical Center, Milwaukee, WI; and Christina D. Williams and Michael J. Kelley, Durham VA Medical Center, Durham, NC.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Gore
authors.affiliation: Rafael Santana-Davila, University of Washington, Seattle, WA; Kiran Devisetty, Michigan State University, Flint, MI; Aniko Szabo and Rodney Sparapani, Medical College of Wisconsin; Rafael Santana-Davila, Carlos Arce-Lara, Elizabeth M. Gore, Amy Moran, and Jeffrey Whittle, Clement J. Zablocki Veterans Affairs (VA) Medical Center, Milwaukee, WI; and Christina D. Williams and Michael J. Kelley, Durham VA Medical Center, Durham, NC.
authors.forename: Amy
authors.initials: A
authors.lastname: Moran
authors.affiliation: Rafael Santana-Davila, University of Washington, Seattle, WA; Kiran Devisetty, Michigan State University, Flint, MI; Aniko Szabo and Rodney Sparapani, Medical College of Wisconsin; Rafael Santana-Davila, Carlos Arce-Lara, Elizabeth M. Gore, Amy Moran, and Jeffrey Whittle, Clement J. Zablocki Veterans Affairs (VA) Medical Center, Milwaukee, WI; and Christina D. Williams and Michael J. Kelley, Durham VA Medical Center, Durham, NC.
authors.forename: Christina D
authors.initials: CD
authors.lastname: Williams
authors.affiliation: Rafael Santana-Davila, University of Washington, Seattle, WA; Kiran Devisetty, Michigan State University, Flint, MI; Aniko Szabo and Rodney Sparapani, Medical College of Wisconsin; Rafael Santana-Davila, Carlos Arce-Lara, Elizabeth M. Gore, Amy Moran, and Jeffrey Whittle, Clement J. Zablocki Veterans Affairs (VA) Medical Center, Milwaukee, WI; and Christina D. Williams and Michael J. Kelley, Durham VA Medical Center, Durham, NC.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kelley
authors.affiliation: Rafael Santana-Davila, University of Washington, Seattle, WA; Kiran Devisetty, Michigan State University, Flint, MI; Aniko Szabo and Rodney Sparapani, Medical College of Wisconsin; Rafael Santana-Davila, Carlos Arce-Lara, Elizabeth M. Gore, Amy Moran, and Jeffrey Whittle, Clement J. Zablocki Veterans Affairs (VA) Medical Center, Milwaukee, WI; and Christina D. Williams and Michael J. Kelley, Durham VA Medical Center, Durham, NC.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Whittle
mesh_terms: D000368:Aged; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D015331:Cohort Studies; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data
chemical_list: D005047:Etoposide; D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin