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BMJ. 2011 Jul 14;343:d4013. doi: 10.1136/bmj.d4013.

Survival and risk of adverse events in older patients receiving postoperative adjuvant chemotherapy for resected stages II-IIIA lung cancer: observational cohort study.

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  • 1Division of General Internal Medicine, Mount Sinai School of Medicine, One Gustave L Levy Place, Box 1087, New York, NY 10029, USA. juan.wisnivesky@mssm.edu

Abstract

OBJECTIVE:

To compare the survival and risk of serious adverse events in older patients with stages II-IIIA non-small cell lung cancer treated with or without postoperative platinum based chemotherapy.

DESIGN:

Observational cohort study.

SETTING:

Cases of lung cancer in Surveillance Epidemiology and End Results registry linked to Medicare files, 1992-2005, and follow-up data to December 2007.

PARTICIPANTS:

3324 patients aged more than 65 years with resected stages II-IIIA lung cancer.

MAIN OUTCOME MEASURES:

Primary outcome was overall survival and secondary outcome was the rate of serious adverse events among older patients treated with or without adjuvant chemotherapy.

RESULTS:

Overall, 21% (n = 684) of patients received platinum based chemotherapy. Analyses adjusted, stratified, or matched by propensity scores showed that chemotherapy was associated with improved survival (hazard ratio range 0.78-0.81). The beneficial effect of chemotherapy was also observed among patients treated with radiation therapy (0.75-0.77) or without radiation therapy (0.74-0.77); however, chemotherapy was not beneficial for patients aged 80 or more (1.32-1.46). Adjuvant chemotherapy was associated with an increased odds of serious adverse events (odds ratio 2.0, 95% confidence interval 1.5 to 2.6).

CONCLUSIONS:

Platinum based adjuvant chemotherapy is associated with reduced mortality and increased risk of serious adverse events in older patients with stages II-IIIA lung cancer. The magnitude of the benefit is similar to that observed in randomised controlled trials carried out among selected patients.

Comment in

PMID:
21757436
[PubMed - indexed for MEDLINE]
PMCID:
PMC3136092
Free PMC Article
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