Chemotherapy improves survival after radiation in certain older patients

A recent study conducted by Apar Kishor Ganti, M.D., UNMC researcher, suggests that chemotherapy following stereotactic body radiotherapy (SBRT), a type of radiation treatment, is associated with improved overall survival in certain patients with lung cancer.

An abstract of the study was presented recently by Dr. Ganti at the 2019 World Conference on Lung Cancer in Barcelona, Spain, sponsored by the International Association for the Study of Lung Cancer.

This study was a retrospective National Cancer Database analysis of 7,934 patients older than age 70 who were diagnosed with (early) clinical stage I-II non-small cell lung cancer (NSCLC) with tumors 4 cm or larger in size or lymph node involvement. The patients were treated between 2004 and 2013 and received SBRT. Among the 6,219 stage I patients, 670 (10.8%) received chemotherapy. Of the remaining 1,715 patients with stage II disease, 742 (43.3%) received chemotherapy.

The researchers found that median overall survival was better with SBRT alone (no chemotherapy) in patients with stage I disease; patients with stage II NSCLC had better overall survival with SBRT plus chemotherapy.

“This study is significant because older patients are often not included in clinical trials, although they make up half of the lung cancer patient population,” said Dr. Ganti, professor of medicine in the UNMC Department of Internal Medicine Division of Oncology/Hematology who also is a staff physician at the Veterans Affairs (VA) Nebraska Western Iowa Health Care System.

“Most studies have demonstrated that older patients benefit as much as younger patients from these interventions, and age alone should not be a factor to determine whether or not older patients get therapy similar to younger patients.

“We showed that adjuvant chemotherapy improves overall survival following SBRT in patients with tumors greater than or equal to 4 cm in size,” Dr. Ganti said. “Older patients, however, are often denied therapy for fear that they may not be able to tolerate it or benefit from it. Hence, we conducted this analysis to evaluate the efficacy of adjuvant chemotherapy following SBRT in older patients.”