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The utilization patterns and comparative effectiveness of systemic therapy with high-dose thoracic radiotherapy or low-dose thoracic radiotherapy versus systemic therapy alone in newly diagnosed metastatic non-small cell lung cancer patients

  • Original Research
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Journal of Radiation Oncology

Abstract

Purpose

We used the National Cancer Database (NCDB) to investigate the utilization and effectiveness of high-dose thoracic radiotherapy (RT) with systemic therapy (ST), compared to low-dose RT with ST, or ST alone in patients with metastatic non-small cell lung cancer (mNSCLC), hypothesizing that the use of high-dose thoracic RT with ST would increase in time and be associated with improved overall survival (OS).

Materials and methods

We identified mNSCLC patients diagnosed between 2004 and 2014 whose initial treatment comprised ST and thoracic RT (ST-RT; n = 46,315) or ST and no thoracic or extrathoracic RT (ST-only; n = 113,009). RT dose was grouped by biologically effective dose (BED10). OS was compared using multivariable regression models and propensity score (PS)–matched analyses.

Results

Median follow-up was 9.1 months and 25.8 months among those alive at last follow-up. Among ST-RT patients, 16.9% and 2.3% received BED10 70–99 Gy (n = 7806) and BED10 ≥ 100 Gy (n = 1049), respectively. Compared to the ST-only group, ST-RT patients receiving a BED10 of 40–69 Gy (HR 0.95, p < 0.001), 70–99 Gy (HR 0.69, p < 0.001), or ≥ 100 Gy (HR 0.68, p < 0.001) had improved OS on multivariable analysis, while patients receiving a BED10 of < 40 Gy (HR 1.40, p < 0.001) did not. Patients who received high-dose RT (BED10 ≥ 70 Gy; HD-RT) had improved OS compared to PS-matched controls in the ST-only group (HR 0.68, p < 0.001). Utilization of HD-RT increased year-by-year over the study period.

Conclusion

HD-RT utilization increased and was associated with improved OS versus ST alone or ST with low-dose RT. These findings are consistent with results from recently published randomized phase II studies.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA

    Justin Budnik, Deepinder P. Singh, Michael D. Stolten, Khush Aujla & Michael T. Milano

  2. Department of Radiation Oncology, University of Florida Health Shands Cancer Hospital, 1515 SW Archer Rd, Gainesville, FL, 32608, USA

    James E. Bates

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  1. Justin Budnik
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Justin Budnik, Michael Milano, and Michael Stolten. The first draft of the manuscript was written by Justin Budnik and Michael Milano, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Justin Budnik.

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This study utilized de-identified registry data which does not meet the definition of human subjects research.

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Budnik, J., Singh, D.P., Stolten, M.D. et al. The utilization patterns and comparative effectiveness of systemic therapy with high-dose thoracic radiotherapy or low-dose thoracic radiotherapy versus systemic therapy alone in newly diagnosed metastatic non-small cell lung cancer patients. J Radiat Oncol 8, 425–438 (2019). https://doi.org/10.1007/s13566-020-00414-2

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