Stage I, non-small cell lung cancer (NSCLC) patients who received radiation therapy have an increased median survival of 21 months compared to 16 months, and the percentage of patients who receive no treatment declined from 20 percent to 16 percent, respectively, when comparing the two eras evaluated, 1999-2003 and 2004-2008, according to detailed analysis of the SEER-17 (Surveillance Epidemiology and End Results, National Cancer Institute) national database presented at the 2012 Chicago Multidisciplinary Symposium in Thoracic Oncology. This symposium is sponsored by the American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO), the International Association for the Study of Lung Cancer (IASLC) and The University of Chicago.
Stage I NSCLC has traditionally been treated effectively with surgery in patients who are otherwise healthy. For patients who are not good candidates for surgery, technological advances in radiation therapy have allowed for high-dose, targeted, non-invasive and painless radiation treatment as an alternative curative option. This study evaluated 53,764 patients with stage I NSCLC-27,469 from 1999-2003 and 26,195 from 2004-2008. The data demonstrated a 12-month increased overall survival for all patients with stage I disease in the later era-from 44 months to 56 months. The proportion of patients who received surgery increased from 64 percent to 70 percent, while the proportion of patients who were treated with radiation therapy alone was relatively stable at 14 percent and 13 percent in the later era. The number of patients who received neither radiation or surgery remained high for both eras-5, 514 patients, or 20 percent, from the earlier period, and 4,218, or 16 percent, in the later time frame.
“Stage I NSCLC patients who receive radiation therapy alone are surviving longer than they used to,” said lead author Nirav S. Kapadia, MD, a chief resident in the department of radiation oncology at the University of Michigan Medical School in Ann Arbor, Mich. “However, at least 16 percent of patients are still not getting the care that they need-care that could save their lives. We must identify the barriers to treatment so that every patient has hope for a cancer cure.”
The abstract, “Patterns of Practice and Outcomes for Stage I, NSCLC: Analysis of SEER-17 Data 1999-2008,” was presented during the Poster Discussion at 5:30 p.m. Central time on September 6, 2012.
Patterns Of Practice And Outcomes For Stage I Non-small Cell Lung Cancer (nsclc): Analysis Of Seer-17 Data 1999-2008
N. S. Kapadia1, F. D. Vigneau2, W. O. Quarshie2, A. G. Schwartz2, F. P. Kong1, 1University of Michigan Hospital Cancer Center, Ann Arbor, Mich., 2Wayne State University School of Medicine, Detroit
Purpose/Objective(s): Surgery has been the only curative option for early-stage non-small cell lung cancer. As recent advances in radiotherapy (RT) allowed dose-escalation and more precise tumor targeting we hypothesize that use of RT increased and outcomes improved in 2004-2008 as compared to 1999-2003.
Materials/Methods: First primary stage I NSCLC cases from the SEER-17 database were used for comparisons between the two eras. Hazard ratios (HR, 95% CI) for death were generated for each era using Cox proportional regression methods based on treatment modality, adjusted for age, sex, race, marital status and year of diagnosis. Histology was added as a predictor to an entire timeframe hazards model and year of diagnosis was replaced by era. Log rank tests were used to compare overall survival differences.
Results: A total of 53,764 patients with stage I NSCLC were included in this analysis (27,469 in the earlier era and 26,195 in the later era). From 1999-2003, 17,463 (64%) patients were treated with primary surgery, 3,969 (14%) with RT alone, 5,514 (20%) received neither treatment, and 2% had unknown treatment. In the later era 18,335 (70%) patients underwent primary surgery, 3,504 (13%) primary RT, 4218 (16%) had neither surgery nor RT and 1% had unknown treatment. Comparing one era to the other, the rates of surgery increased although there was no significant difference in the number of patients who received radiotherapy either as an adjunct to surgery (HR 0.95, 0.74-1.21) or as definitive therapy (HR 1.05, 0.94 – 1.17).
For the entire timeframe, important factors associated with higher risk of death after primary RT or surgery included age (HR 1.03, 1.03-1.03) African-American race (HR 1.05, 1.00-1.09), large cell (HR 1.29, 1.21-1.37) or squamous histology (HR 1.27, 1.23-1.31) and being unmarried (HR>1.17 for each strata). Important protective factors included female sex (HR 0.72, 0.71-0.74) and race listed as ‘other’ (HR 0.82, 95% CI 0.77-0.87).
Overall survival between the eras significantly increased from 44 (43-46) to 56 (54-58) months. A change in the survival of patients treated with surgery could not be detected, as median survival has not yet been reached. For patients treated with RT alone, median survival significantly improved from 16 (16-17) to 21 (20-22) months.
Conclusions: The rate of use of surgery has increased and the rate of use of radiotherapy remains stable between the two eras queried. Overall survival for stage I NSCLC has improved significantly for all patients and for those treated with primary RT, while survival after surgery remains excellent though an improvement could not be detected. Further research into whether improved patient selection or technical factors belies these observations will increase our understanding and guide future therapeutic decision making.
Author Disclosure Block: N.S. Kapadia: None. F.D. Vigneau: None. W.O. Quarshie: None. A.G. Schwartz: None. F.P. Kong: None.