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Chemoradiotherapy Survival Benefit in Elderly Patients With Limited-Stage SCLC

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Key Points

  • Chemoradiotherapy was associated with increased overall survival vs chemotherapy alone.
  • The significant improvement was maintained in a propensity score matching analysis.

In a population-based study reported in the Journal of Clinical Oncology, Corso et al found that chemoradiotherapy was associated with an overall survival benefit vs chemotherapy in elderly patients with limited-stage small cell lung cancer (SCLC).

Study Details

The study involved National Cancer Data Base data from 8,637 patients aged ≥ 70 years with limited-stage SCLC of clinical stage I to III who received chemoradiotherapy (n = 4,862, 56%) or chemotherapy (n = 3,775, 44%) between 2003 and 2011.

Factors associated with a greater likelihood of receiving chemotherapy vs chemoradiotherapy included greater age (P < .001), female sex (P = .003), clinical stage III (P < .001), medical comorbidities (P < .001), higher estimated median household income (P = .03), and residence in an urban setting (P < .001).

Improved Overall Survival

Median estimated overall survival was 15.6 months among patients receiving chemoradiotherapy and 9.3 months among those receiving chemotherapy alone (P < .001), with 3-year overall survival rates of 22.0% vs 6.3%. The survival benefit was maintained in a sensitivity analysis excluding patients who died within 3 months of diagnosis (P < .001). Chemoradiotherapy was associated with improved survival on both univariate (hazard ratio [HR] = 0.50, P < .001) and multivariate analysis (HR = 0.52, P < .001).

Propensity score matching analysis using a cohort of 6,856 patients well-matched for all factors significantly associated with survival on multivariate analysis showed similar improvement in overall survival (HR = 0.52,  P <.001); 3-year overall survival in this cohort was 20.6% vs 6.6%. A subset analysis among chemoradiotherapy patients alive 4 months after diagnosis indicated a survival benefit among patients receiving concurrent vs sequential chemoradiotherapy (median = 17.0 vs 15.4 months, P = .01).

The investigators concluded: “In elderly patients with limited-stage small-cell lung cancer, modern [chemoradiotherapy] appears to confer an additional [overall survival] advantage beyond that achieved with [chemotherapy] alone in a large population-based cohort. Our findings suggest that [chemoradiotherapy] should be the preferred strategy in elderly patients who are expected to tolerate the toxicities of the combined approach.”

Roy H. Decker, MD, PhD, of Yale University School of Medicine, is the corresponding author for the Journal of Clinical Oncology article. For full disclosures of the study authors, visit jco.ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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