Inoperable early stage non-small cell lung cancer: Comorbidity, patterns of care and survival

• Published in: Lung cancer (Amsterdam, Netherlands) Netherlands), 2011-04, Vol.72 (1), p.39-44
• Main Authors: Smith, S.L, Palma, D, Parhar, T, Alexander, C.S, Wai, E.S
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - radiotherapy; Charlson comorbidity index; Early stage; Female; Hematology, Oncology and Palliative Medicine; Humans; Inoperable; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - radiotherapy; Male; Medical sciences; Middle Aged; Neoplasm Staging; Non-small cell lung cancer; Palliative care; Pneumology; Pulmonary/Respiratory; Radiotherapy; Retrospective Studies; Risk Factors; Survival Analysis; Tumors; Tumors of the respiratory system and mediastinum
• ISSN: 0169-5002; 1872-8332
• DOI: 10.1016/j.lungcan.2010.07.015

Abstract Purpose To evaluate comorbidities, patterns of care and outcomes for patients with inoperable stage I and II non-small cell lung cancer (NSCLC). Materials and methods Patients diagnosed with stage I or II NSCLC in British Columbia between 1996 and 2005 who did not undergo primary surgery and were referred for oncology assessment were identified in a retrospective analysis. Baseline comorbidity and pulmonary function data for patients treated with curative radiotherapy (CurRT; biologically effective dose [BED] > 58 Gy10 ) were abstracted by chart review. Kaplan–Meier and Cox regression were used to determine factors associated with overall survival (OS) and cause-specific survival (CSS) based on treatment group [no radiotherapy (NoRT), palliative radiotherapy (PallRT), or CurRT]. Results Of 1043 patients identified, approximately 1/3 received CurRT, and these patients had better performance status and lower stage disease than the other groups. There was a high prevalence of comorbid conditions in the CurRT group; 90% of CurRT patients had an age-adjusted Charlson comorbidity index (CCI) score ≥5. CurRT patients had a median survival 1-year longer than patients treated with PallRT or NoRT ( p < 0.0001). In CurRT patients, CCI was predictive of OS (HR 1.1 per point CCI increase; p = 0.044), but not CSS. Patients receiving PallRT with a BED > 50 Gy10 had significantly longer OS than those receiving PallRT of ≤50 Gy10 ( p < 0.0001). Conclusions Treatment of medically inoperable early stage NSCLC patients with CurRT is associated with a significantly longer survival, and for these patients CCI is a significant predictor of OS. For patients treated with PallRT, higher doses of palliative thoracic RT is associated with improved OS.