Radiation Therapy is Independently Associated with Worse Survival After R0-Resection for Stage I-II Non-small Cell Lung Cancer: An Analysis of the National Cancer Data Base.
BACKGROUND
The 1998 post-operative radiotherapy meta-analysis for lung cancer showed a survival detriment associated with radiation for stage I-II resected non-small cell lung cancer (NSCLC), but has been criticized for including antiquated radiation techniques. We analyzed the National Cancer Database (NCDB) to determine the impact of radiation after margin-negative (R0) resection for stage I-II NSCLC on survival.


METHODS
Adult patients from 2004 to 2014 were analyzed from the NCDB with respect to receiving radiation as part of their first course of treatment for resected stage I-II NSCLC; the primary outcome measure was overall survival.


RESULTS
A total of 197,969 patients underwent R0 resection for stage I-II NSCLC, and 4613 received radiation. Median radiation dose was 55 Gy with a 50-60 Gy interquartile range. On adjusted analysis, treatment at a community cancer program, sublobectomy, tumor size (3-7 cm), and pN1/Nx were associated with receiving radiation (odds ratio > 1, p < 0.05). The irradiated group had shorter median survival (45.8 vs. 77.5 months, p < 0.001), and radiation was independently associated with worse overall survival (hazard ratio (HR) 1.339, 95% confidence interval (CI) 1.282-1.399). After propensity score matching, radiation remained associated with worse overall survival (HR 1.313, 95% CI 1.237-1.394, p < 0.001).


CONCLUSIONS
Radiotherapy was independently associated with worse survival after R0 resection of stage I-II NSCLC in the NCDB and was more likely to be delivered in community cancer programs.
Baylor College of Medicine, Houston, TX, USA.
Todd A
TA
Pezzi
Division of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.|Department of Clinical Oncology and Nuclear Medicine, Alexandria University, Alexandria, Egypt.
Abdallah S R
AS
Mohamed
Division of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
Clifton D
CD
Fuller
Division of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.|Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France.
Pierre
P
Blanchard
Department of Surgery, Abington Hospital-Jefferson Health, Abington, PA, USA.
Christopher
C
Pezzi
Division of Surgery, Department of Thoracic and Cardiovascular Surgery, University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
Boris
B
Sepesi
Division of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
Stephen M
SM
Hahn
Division of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
Daniel R
DR
Gomez
Division of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA. sgchun@mdanderson.org.
Stephen G
SG
Chun
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D008297:Male; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D011013:Pneumonectomy; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D014481:United States