Department of Radiation Oncology, The Ohio State University, Columbus, Ohio.
College of Public Health, The Ohio State University, Columbus, Ohio.
J Thorac Oncol. 2018 Mar;13(3):426-435. doi: 10.1016/j.jtho.2017.11.135. Epub 2018 Jan 8.
Elderly patients account for the majority of lung cancer diagnoses but are poorly represented in clinical trials. We evaluated the overall survival (OS) of elderly patients with stage III NSCLC treated with definitive radiation compared with that of patients treated with definitive chemoradiation.
We conducted a comparative effectiveness study of radiation therapy versus chemoradiation in elderly (≥70 years old) patients with stage III NSCLC not treated surgically diagnosed from 2003 to 2014; the patients were identified by using the National Cancer Database. Two cohorts were evaluated: patients (n = 5023) treated with definitive radiation (≥59.4 Gy) and patients (n = 18,206) treated with definitive chemoradiation. Chemoradiation was further defined as concurrent (radiation and chemotherapy started within 30 days of each other) or sequential (radiation started >30 days after chemotherapy). We compared OS between the treatment groups by using the Kaplan-Meier method and Cox proportional hazards regression before and after propensity score matching (PSM).
Treatment with chemoradiation was associated with improved OS versus that with radiation both before PSM (hazard ratio [HR] = 0.66, 95% confidence interval [CI]: 0.64-0.68, p < 0.001) and after PSM (HR = 0.67, 95% CI: 0.64-0.70, p < 0.001). Relative to concurrent chemoradiation, sequential chemoradiation was associated with a 9% reduction in the risk for death (HR = 0.91, 95% CI: 0.85-0.96, p = 0.002).
We found that definitive chemoradiation resulted in a survival advantage compared with definitive radiation in elderly patients. Sequential chemotherapy and radiation was superior to concurrent chemoradiation. Although prospective trials are needed, this analysis suggests that chemoradiation should be strongly considered for elderly patients and the optimal sequencing of chemotherapy and radiation remains an unanswered question for this patient population.
老年患者占肺癌诊断的大多数，但在临床试验中代表性不足。我们评估了接受根治性放疗与根治性放化疗治疗的 III 期非小细胞肺癌老年患者的总生存期（OS）。
我们对 2003 年至 2014 年间未经手术诊断的 III 期非小细胞肺癌老年（≥70 岁）患者进行了放疗与放化疗的比较有效性研究；通过国家癌症数据库确定了两组患者：5023 例接受根治性放疗（≥59.4Gy）的患者和 18206 例接受根治性放化疗的患者。放化疗进一步定义为同步（放疗和化疗在彼此 30 天内开始）或序贯（化疗开始>30 天之后开始放疗）。我们通过 Kaplan-Meier 方法和倾向评分匹配（PSM）前后的 Cox 比例风险回归比较了两组之间的 OS。
在 PSM 之前（HR=0.66，95%CI：0.64-0.68，p<0.001）和 PSM 之后（HR=0.67，95%CI：0.64-0.70，p<0.001），与放疗相比，放化疗治疗与 OS 改善相关。与同步放化疗相比，序贯放化疗死亡风险降低 9%（HR=0.91，95%CI：0.85-0.96，p=0.002）。
我们发现，与根治性放疗相比，老年患者接受根治性放化疗可获得生存优势。序贯化疗和放疗优于同步放化疗。尽管需要前瞻性试验，但该分析表明，放化疗应强烈考虑用于老年患者，而对于这一患者群体，化疗和放疗的最佳序贯仍未得到解答。
