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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2017

01-05-2017 | Radiation Oncology

Radiation Therapy is Independently Associated with Worse Survival After R0-Resection for Stage I–II Non-small Cell Lung Cancer: An Analysis of the National Cancer Data Base

Authors: Todd A. Pezzi, BS, Abdallah S. R. Mohamed, MD, MSc, Clifton D. Fuller, MD, PhD, Pierre Blanchard, MD, PhD, Christopher Pezzi, MD, Boris Sepesi, MD, Stephen M. Hahn, MD, Daniel R. Gomez, MD, Stephen G. Chun, MD

Published in: Annals of Surgical Oncology | Issue 5/2017

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Abstract

Background

The 1998 post-operative radiotherapy meta-analysis for lung cancer showed a survival detriment associated with radiation for stage I–II resected non-small cell lung cancer (NSCLC), but has been criticized for including antiquated radiation techniques. We analyzed the National Cancer Database (NCDB) to determine the impact of radiation after margin-negative (R0) resection for stage I–II NSCLC on survival.

Methods

Adult patients from 2004 to 2014 were analyzed from the NCDB with respect to receiving radiation as part of their first course of treatment for resected stage I–II NSCLC; the primary outcome measure was overall survival.

Results

A total of 197,969 patients underwent R0 resection for stage I–II NSCLC, and 4613 received radiation. Median radiation dose was 55 Gy with a 50–60 Gy interquartile range. On adjusted analysis, treatment at a community cancer program, sublobectomy, tumor size (3–7 cm), and pN1/Nx were associated with receiving radiation (odds ratio > 1, p < 0.05). The irradiated group had shorter median survival (45.8 vs. 77.5 months, p < 0.001), and radiation was independently associated with worse overall survival (hazard ratio (HR) 1.339, 95% confidence interval (CI) 1.282–1.399). After propensity score matching, radiation remained associated with worse overall survival (HR 1.313, 95% CI 1.237–1.394, p < 0.001).

Conclusions

Radiotherapy was independently associated with worse survival after R0 resection of stage I–II NSCLC in the NCDB and was more likely to be delivered in community cancer programs.
Appendix
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Metadata
Title
Radiation Therapy is Independently Associated with Worse Survival After R0-Resection for Stage I–II Non-small Cell Lung Cancer: An Analysis of the National Cancer Data Base
Authors
Todd A. Pezzi, BS
Abdallah S. R. Mohamed, MD, MSc
Clifton D. Fuller, MD, PhD
Pierre Blanchard, MD, PhD
Christopher Pezzi, MD
Boris Sepesi, MD
Stephen M. Hahn, MD
Daniel R. Gomez, MD
Stephen G. Chun, MD
Publication date
01-05-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 5/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-5786-6

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