Survival Outcomes With Thoracic Radiotherapy in Extensive-Stage Small-Cell Lung Cancer: A Propensity Score-Matched Analysis of the National Cancer Database

Sibo Tian, Xinyan Zhang, Renjian Jiang, Rathi N. Pillai, Taofeek K. Owonikoko, Conor E. Steuer, Nabil F. Saba, Suchita Pakkala, Pretesh R. Patel, Chandra P. Belani, Fadlo R. Khuri, Walter J. Curran, Suresh S. Ramalingam, Madhusmita Behera, Kristin A. Higgins

Research output: Contribution to journalArticle

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 languageEnglish (US)
Pages (from-to)484-493.e6
JournalClinical Lung Cancer
Volume20
Issue number6
DOIs
StatePublished - Nov 2019

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Propensity Score
Small Cell Lung Carcinoma
Radiotherapy
Thorax
Databases
Drug Therapy
Survival
Neoplasms
Confidence Intervals
Standard of Care
Multivariate Analysis
Neoplasm Metastasis

All Science Journal Classification (ASJC) codes

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

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. / Survival Outcomes With Thoracic Radiotherapy in Extensive-Stage Small-Cell Lung Cancer : A Propensity Score-Matched Analysis of the National Cancer Database. In: Clinical Lung Cancer. 2019 ; Vol. 20, No. 6. pp. 484-493.e6.
@article{1b2b44635a4143daa229c6aec982e347,
title = "Survival Outcomes With Thoracic Radiotherapy in Extensive-Stage Small-Cell Lung Cancer: A Propensity Score-Matched Analysis of the National Cancer Database",
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.",
author = "Sibo Tian and Xinyan Zhang and Renjian Jiang and Pillai, {Rathi N.} and Owonikoko, {Taofeek K.} and Steuer, {Conor E.} and Saba, {Nabil F.} and Suchita Pakkala and Patel, {Pretesh R.} and Belani, {Chandra P.} and Khuri, {Fadlo R.} and Curran, {Walter J.} and Ramalingam, {Suresh S.} and Madhusmita Behera and Higgins, {Kristin A.}",
year = "2019",
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doi = "10.1016/j.cllc.2019.06.014",
language = "English (US)",
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pages = "484--493.e6",
journal = "Clinical Lung Cancer",
issn = "1525-7304",
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Tian, S, Zhang, X, Jiang, R, Pillai, RN, Owonikoko, TK, Steuer, CE, Saba, NF, Pakkala, S, Patel, PR, Belani, CP, Khuri, FR, Curran, WJ, Ramalingam, SS, Behera, M & Higgins, KA 2019, 'Survival Outcomes With Thoracic Radiotherapy in Extensive-Stage Small-Cell Lung Cancer: A Propensity Score-Matched Analysis of the National Cancer Database', Clinical Lung Cancer, vol. 20, no. 6, pp. 484-493.e6. https://doi.org/10.1016/j.cllc.2019.06.014

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 journalArticle

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.

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