1 Radiotherapy and Chemotherapy for Elderly Patients with Stage I - II Unresected Lung Cancer

COI disclosure: JPW is a member of the research board of EHE International, has received lecture honorarium from Novartis Pharmaceutical, and was awarded a research grant from GlaxoSmithKline to conduct a COPD study. EAH, MB, LL, and GM, have no conflict of interest to declare. Abstract Purpose: Radiotherapy (RT) is the standard therapy for unresected stage I-II non-small cell lung cancer (NSCLC). Using population-based data, we compared survival and toxicity among unresected elderly patients treated with combined chemoradiotherapy (CRT) or RT alone. Methods: Using the Surveillance, Epidemiology and End Results-Medicare registry we identified 3,006 cases of unresected stage I-II NSCLC. We used propensity score methods to compare survival and rates of toxicity of patients treated with RT vs. CRT. Results: Overall, 844 (28%) patients received CRT. Adjusted analyses showed that CRT was associated with improved survival (HR: 0.85; 95% CI: 0.78-0.94). Combination therapy was also associated with better survival among stage I patients treated with intermediate complexity RT (HR: 0.80; 95% CI: 0.70-0.90); however, no difference in survival was observed among patients treated with complex RT. In Stage II patients, CRT was associated with improved survival regardless of the RT technique (HR: 0.61-0.72). CRT was associated with increased odds of toxicity. Conclusions: Despite increased toxicity, CRT may improve survival of elderly unresected patients with stage II disease as well as stage I NSCLC treated with intermediate RT complexity. Randomized trials are needed to better clarify the balance of benefits and risk of CRT in unresected patients.