Older Lung Cancer Patients Survival Not Improved by Postoperative Radiotherapy

Researchers have demonstrated that postoperative radiation therapy (PORT), a controversial yet frequently administered treatment for lung cancer, may not prolong life in the elderly with locally advanced disease.

The study’s findings were published in the February 13, 2012, online edition of Cancer, a peer-reviewed journal of the American Cancer Society. In patients with non-small-cell lung cancer (NSCLC), the standard of care is surgery to remove the tumor. However, in patients with stage III disease and involvement of a type of lymph node called N2, clinicians will frequently order a course of PORT to improve outcomes.

“While some analyses have shown improvement with PORT, the data are not strong enough to support using it as a standard of care in older adults with this type of lung cancer,” said Juan Wisnivesky, MD, DPH, vice-chair for research in the department of medicine at Mount Sinai School of Medicine (New York, NY, USA) and lead author on the study. “Our results show that we need more information about the potential benefits of radiation therapy before it is used routinely to treat these patients, especially considering the side effects associated with it.”

The researchers identified 1,307 cases of stage III NSCLC with N2 lymph node involvement between 1992 and 2005 using the Surveillance, Epidemiology and End Results (SEER)-Medicare registry, which correlates cancer incidence and survival data to a master file of US Medicare records. Overall, 710 (54%) of these patients aged 66 and older received PORT after their tumor was removed. The researchers discovered that one-year and three-year survival was not improved in the group receiving PORT compared to the group that did not receive it. The researchers concluded that use of PORT should be limited until validated data are available.

“Our study indicates that clinicians should refrain from widespread use of PORT in elderly patients with this cancer subtype until we know more,” concluded Dr. Wisnivesky. “A randomized and controlled trial is required to fully assess any benefit, and such trials are ongoing now.”

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