Abstract
Background: The prognosis of patients with extensive-stage small-cell lung carcinoma (ES-SCLC) is poor. The benefit of consolidative thoracic radiation therapy (TRT) in ES-SCLC has been inconclusive, and its use inconsistent. The objective of this study was to evaluate overall survival (OS) of ES-SCLC patients treated with chemotherapy (CT) with or without TRT using an administrative database approach. Patients and Methods: The National Cancer Database was queried to identify patients with ES-SCLC diagnosed between 2010 and 2014. Those with brain metastases, those who received radiotherapy before CT, or radiotherapy outside the thorax, were excluded. Propensity score-matching (PSM) was used to compare OS of patients treated with CT and TRT with those who received CT alone. Patients who received >10 radiotherapy fractions were also compared with those who received 10 or fewer. Results: We included 14,367 patients in the primary analysis; 12,019 received CT alone, and 2348 received CT with TRT. In multivariate analysis, CT was associated with an increased risk of death relative to CT with TRT (hazard ratio [HR], 1.74 [95% confidence interval (CI), 1.64-1.84]; log-rank P < .001), which remained significant with PSM. Median OS was 12.1 versus 8.2 months (CT with TRT vs. CT); 12-month OS was 50.5% versus 28.5%, and 5-year OS 7.6% versus 2.0% (HR, 1.80 [95% CI, 1.67-1.95], HR P < .001). Of 3099 patients who received TRT, >10 radiotherapy fractions was associated with superior OS (HR, 1.70 [95% CI, 1.49-1.95], log-rank P < .001); this finding remained significant with PSM. Conclusion: Use of TRT after CT in ES-SCLC patients was associated with long-term survival; its use should be considered in addition to standard of care CT.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 484-493.e6 |
| Journal | Clinical Lung Cancer |
| Volume | 20 |
| Issue number | 6 |
| DOIs | |
| State | Published - Nov 2019 |
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All Science Journal Classification (ASJC) codes
- Oncology
- Pulmonary and Respiratory Medicine
- Cancer Research
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Survival Outcomes With Thoracic Radiotherapy in Extensive-Stage Small-Cell Lung Cancer : A Propensity Score-Matched Analysis of the National Cancer Database. / Tian, Sibo; Zhang, Xinyan; Jiang, Renjian; Pillai, Rathi N.; Owonikoko, Taofeek K.; Steuer, Conor E.; Saba, Nabil F.; Pakkala, Suchita; Patel, Pretesh R.; Belani, Chandra P.; Khuri, Fadlo R.; Curran, Walter J.; Ramalingam, Suresh S.; Behera, Madhusmita; Higgins, Kristin A.
In: Clinical Lung Cancer, Vol. 20, No. 6, 11.2019, p. 484-493.e6.Research output: Contribution to journal › Article
TY - JOUR
T1 - Survival Outcomes With Thoracic Radiotherapy in Extensive-Stage Small-Cell Lung Cancer
T2 - A Propensity Score-Matched Analysis of the National Cancer Database
AU - Tian, Sibo
AU - Zhang, Xinyan
AU - Jiang, Renjian
AU - Pillai, Rathi N.
AU - Owonikoko, Taofeek K.
AU - Steuer, Conor E.
AU - Saba, Nabil F.
AU - Pakkala, Suchita
AU - Patel, Pretesh R.
AU - Belani, Chandra P.
AU - Khuri, Fadlo R.
AU - Curran, Walter J.
AU - Ramalingam, Suresh S.
AU - Behera, Madhusmita
AU - Higgins, Kristin A.
PY - 2019/11
Y1 - 2019/11
N2 - Background: The prognosis of patients with extensive-stage small-cell lung carcinoma (ES-SCLC) is poor. The benefit of consolidative thoracic radiation therapy (TRT) in ES-SCLC has been inconclusive, and its use inconsistent. The objective of this study was to evaluate overall survival (OS) of ES-SCLC patients treated with chemotherapy (CT) with or without TRT using an administrative database approach. Patients and Methods: The National Cancer Database was queried to identify patients with ES-SCLC diagnosed between 2010 and 2014. Those with brain metastases, those who received radiotherapy before CT, or radiotherapy outside the thorax, were excluded. Propensity score-matching (PSM) was used to compare OS of patients treated with CT and TRT with those who received CT alone. Patients who received >10 radiotherapy fractions were also compared with those who received 10 or fewer. Results: We included 14,367 patients in the primary analysis; 12,019 received CT alone, and 2348 received CT with TRT. In multivariate analysis, CT was associated with an increased risk of death relative to CT with TRT (hazard ratio [HR], 1.74 [95% confidence interval (CI), 1.64-1.84]; log-rank P < .001), which remained significant with PSM. Median OS was 12.1 versus 8.2 months (CT with TRT vs. CT); 12-month OS was 50.5% versus 28.5%, and 5-year OS 7.6% versus 2.0% (HR, 1.80 [95% CI, 1.67-1.95], HR P < .001). Of 3099 patients who received TRT, >10 radiotherapy fractions was associated with superior OS (HR, 1.70 [95% CI, 1.49-1.95], log-rank P < .001); this finding remained significant with PSM. Conclusion: Use of TRT after CT in ES-SCLC patients was associated with long-term survival; its use should be considered in addition to standard of care CT.
AB - Background: The prognosis of patients with extensive-stage small-cell lung carcinoma (ES-SCLC) is poor. The benefit of consolidative thoracic radiation therapy (TRT) in ES-SCLC has been inconclusive, and its use inconsistent. The objective of this study was to evaluate overall survival (OS) of ES-SCLC patients treated with chemotherapy (CT) with or without TRT using an administrative database approach. Patients and Methods: The National Cancer Database was queried to identify patients with ES-SCLC diagnosed between 2010 and 2014. Those with brain metastases, those who received radiotherapy before CT, or radiotherapy outside the thorax, were excluded. Propensity score-matching (PSM) was used to compare OS of patients treated with CT and TRT with those who received CT alone. Patients who received >10 radiotherapy fractions were also compared with those who received 10 or fewer. Results: We included 14,367 patients in the primary analysis; 12,019 received CT alone, and 2348 received CT with TRT. In multivariate analysis, CT was associated with an increased risk of death relative to CT with TRT (hazard ratio [HR], 1.74 [95% confidence interval (CI), 1.64-1.84]; log-rank P < .001), which remained significant with PSM. Median OS was 12.1 versus 8.2 months (CT with TRT vs. CT); 12-month OS was 50.5% versus 28.5%, and 5-year OS 7.6% versus 2.0% (HR, 1.80 [95% CI, 1.67-1.95], HR P < .001). Of 3099 patients who received TRT, >10 radiotherapy fractions was associated with superior OS (HR, 1.70 [95% CI, 1.49-1.95], log-rank P < .001); this finding remained significant with PSM. Conclusion: Use of TRT after CT in ES-SCLC patients was associated with long-term survival; its use should be considered in addition to standard of care CT.
UR - http://www.scopus.com/inward/record.url?scp=85068451130&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85068451130&partnerID=8YFLogxK
U2 - 10.1016/j.cllc.2019.06.014
DO - 10.1016/j.cllc.2019.06.014
M3 - Article
C2 - 31296433
AN - SCOPUS:85068451130
VL - 20
SP - 484-493.e6
JO - Clinical Lung Cancer
JF - Clinical Lung Cancer
SN - 1525-7304
IS - 6
ER -