More patients with early-stage non–small cell lung cancer (NSCLC) are now surviving for at least 2 years following their diagnosis, largely because they are more likely to be treated with curative intent, a large, population-based database suggests.
Regardless of treatment received, the 2-year rate of overall survival (OS) improved from 61% in 2000 to 70% in 2009 among more than 67,000 patients diagnosed with stage I NSCLC, investigators report.
“Anecdotally, we noted that more patients are being offered curative-intent therapy due to increasing sophistication of treatment (radiation or surgery) techniques,” Nirav Kapadia, MD, a radiation oncologist at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, who was lead study author, told Medscape Medical News in an email.
“The recent Centers for Medicare & Medicaid Services approval of low-dose CT screening will likely also increase the number of early-stage lung cancers that are detected, so we felt it was important to understand the trajectory of how patients are faring after diagnosis and treatment, using the most up-to-date data available,” he added.
The study was published online October 26 in the Annals of Thoracic Surgery.
The researchers relied on the Surveillance, Epidemiology, and End Results (SEER)–18 database to identify 67,197 patients with stage I NSCLC who were registered in SEER-18 between January 2000 and December 2010.
From 2000 to 2010, 62% of the cohort were treated with some form of surgery, 15% received radiotherapy (RT), 3% received both surgery and RT, and 18% of patients remained untreated.
More than half (58%) of all patients in 2000 were treated with surgery, the study authors note.
In 2010, this percentage increased to 63.9%. The proportion of patients treated with sublobar resection increased steadily from 12.9% in 2000 to 17.9% in 2010, they add.
The proportion of patients treated with definitive RT also increased during the same period, from 17.2% in 2000 to 18.3% in 2010.
In contrast, “the odds a patient received both treatments did not significantly change over time,” the investigators observe.
The proportion of untreated patients declined from 20.2% in 2000 to 15.3% in 2010.
Perhaps reflecting the steady uptake of definitive treatment over time, OS rates also increased from 2000 to 2010 for both surgical and RT cohorts.
Overall, there was a 3.5% decrease in mortality risk each year, independent of whether patients were treated surgically or with definitive RT alone.
On the other hand, the survival benefits seen during the study period were greater for patients treated with RT than for those treated with some form of surgery.
“We found that the largest survival improvements [were] in patients undergoing definitive radiation therapy, so our stance is that patients who are not surgical candidates for one reason or another, including their own preference, should be referred to a radiation oncologist,” Dr Kapadia said.
Advances in radiation technology, notably in the use of stereotactic body RT (SBRT), which improves local control, may enable the approach to work as well in early NSCLC as it does in advanced-stage disease, the investigators suggest.
Interestingly, survival rates did not change among patients who received both surgery and RT, the study authors note.
Dr Kapadia speculated that for patients who were treated with RT following surgery, the resections that they underwent may have been incomplete, and so they may have received fractionated RT as opposed to the more effective SBRT.
“To the best of our knowledge, this was the first study to look at stage-specific diagnoses and break them down by if and how patients were treated,” Dr Kapadia said in a statement.
“Our study optimistically suggests that if current trends persist, survival for NSCL will continue to improve over time,” he added.
The study was funded by a research grant from the Woodworth family. Dr Kapadia has disclosed no relevant financial relationships.
Ann Thorac Surg. Published online October 26, 2017. Abstract
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