ATS: Radiation Offers Modest Boost for Frail Lung Cancer Pat

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http://www.medpagetoday.com/tbindex.cfm ... topicid=24

By Brian Vastag, MedPage Today Staff Writer

Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.

May 27, 2005

Review

SAN DIEGO, May 27-Early stage non-small-cell lung cancer (NSCLC) patients contraindicated for surgery can expect a five- to seven-month boost in life expectancy from radiation therapy.

So it appears from an analysis of the National Cancer Institute's tumor registry, providing clinicians with guidance for a relatively uncommon yet grim scenario. The finding was presented by Juan Wisnivesky, M.D., of the Mount Sinai School of Medicine in New York at the American Thoracic Society meeting here.

"Physicians should push to make sure all patients are operated on," said Dr. Wisnivesky. However, some 25% of patients diagnosed with stage I and II non-small cell lung cancer do not undergo surgery. Many have comorbidities that prevent surgery, some reject surgery, and some are not offered surgery for unknown reasons, said Dr. Wisnivesky. His database analysis could not determine the proportion of patients in each category.

Yet the analysis found that about half of non-surgical early-stage NSCLC patients receive radiation treatment. Dr. Wisnivesky says that, in light of the new analysis, this figure is too low. "This is something we need to do for these patients," he said.

Mining the NCI's Surveillance, Epidemiology, and End Results (SEER) cancer registry, Dr. Wisnivesky and colleagues analyzed information from 4,567 patients diagnosed with stage I or II lung cancer between 1988 and 2001. Some 88% were diagnosed with stage I lung cancer; the rest (12%) were stage II.

The stage I patients who did not receive radiotherapy had a life expectancy of 14 months; radiation extended that figure to 21 months (p = 0.0001). For stage II patients, the corresponding figures were 9 and 14 months (p = 0.0001).

"The good news is that radiation extends life expectancy, but unfortunately, it is only for a few months," said Dr. Wisnivesky. He is now linking the NCI database with information from Medicare to help determine why some early lung cancer patients do not have surgery.

The SEER database collects detailed data on all newly diagnosed cases of cancer in selected regions. It covers 26% of the US population and accurately reflects the demographics of the nation.