Effect of Radiotherapy Planning Complexity on Survival of Elderly Patients With Unresected Localized Lung Cancer

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• 作者：Chang H. Park B.A.^&lowast ; ; Marcelo Bonomi M.D.^&dagger ; ; Jamie Cesaretti M.D.^&Dagger ; ; Alfred I. Neugut M.D. ; Ph.D.^§ ; ;   ; ^?/sup> ; Juan P. Wisnivesky M.D. ; Dr.P.H.^¶ ; ;   ; ^{juan.wisnivesky@mssm.edu}
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2011
• 出版时间：1 November 2011
• 年：2011
• 卷：81
• 期：3
• 页码：706-711
• 全文大小：93 K

文摘

Purpose

To evaluate whether complex radiotherapy (RT) planning was associated with improved outcomes in a cohort of elderly patients with unresected Stage I¨CII non¨Csmall-cell lung cancer (NSCLC).

Methods and Materials

Using the Surveillance, Epidemiology, and End Results registry linked to Medicare claims, we identified 1998 patients aged >65 years with histologically confirmed, unresected stage I¨CII NSCLC. Patients were classified into an intermediate or complex RT planning group using Medicare physician codes. To address potential selection bias, we used propensity score modeling. Survival of patients who received intermediate and complex simulation was compared using Cox regression models adjusting for propensity scores and in a stratified and matched analysis according to propensity scores.

Results

Overall, 25 % of patients received complex RT planning. Complex RT planning was associated with better overall (hazard ratio 0.84; 95 % confidence interval, 0.75-0.95) and lung cancer¨Cspecific (hazard ratio 0.81; 95 % confidence interval, 0.71?.93) survival after controlling for propensity scores. Similarly, stratified and matched analyses showed better overall and lung cancer¨Cspecific survival of patients treated with complex RT planning.

Conclusions

The use of complex RT planning is associated with improved survival among elderly patients with?unresected Stage I¨CII NSCLC. These findings should be validated in prospective randomized controlled trials.