Introduction: Elderly patients account for the majority of lung cancer diagnoses but are poorly represented in clinical trials. We evaluated the overall survival (OS) of elderly patients with stage III NSCLC treated with definitive radiation compared with that of patients treated with definitive chemoradiation. Methods: We conducted a comparative effectiveness study of radiation therapy versus chemoradiation in elderly (≥70 years old) patients with stage III NSCLC not treated surgically diagnosed from 2003 to 2014; the patients were identified by using the National Cancer Database. Two cohorts were evaluated: patients (n = 5023) treated with definitive radiation (≥59.4 Gy) and patients (n = 18,206) treated with definitive chemoradiation. Chemoradiation was further defined as concurrent (radiation and chemotherapy started within 30 days of each other) or sequential (radiation started >30 days after chemotherapy). We compared OS between the treatment groups by using the Kaplan‐Meier method and Cox proportional hazards regression before and after propensity score matching (PSM). Results: Treatment with chemoradiation was associated with improved OS versus that with radiation both before PSM (hazard ratio [HR] = 0.66, 95% confidence interval [CI]: 0.64–0.68, p < 0.001) and after PSM (HR = 0.67, 95% CI: 0.64–0.70, p < 0.001). Relative to concurrent chemoradiation, sequential chemoradiation was associated with a 9% reduction in the risk for death (HR = 0.91, 95% CI: 0.85–0.96, p = 0.002). Conclusions: We found that definitive chemoradiation resulted in a survival advantage compared with definitive radiation in elderly patients. Sequential chemotherapy and radiation was superior to concurrent chemoradiation. Although prospective trials are needed, this analysis suggests that chemoradiation should be strongly considered for elderly patients and the optimal sequencing of chemotherapy and radiation remains an unanswered question for this patient population.

中文翻译：

---

放疗联合化疗可提高老年 III 期非小细胞肺癌患者的生存率

简介：老年患者占肺癌诊断的大部分，但在临床试验中的代表性不足。我们评估了接受根治性放疗的 III 期 NSCLC 老年患者与接受根治性放化疗的患者的总生存期 (OS)。方法：我们对 2003 年至 2014 年未接受手术治疗的老年（≥70 岁）III 期 NSCLC 患者进行了放疗与放化疗的比较有效性研究；这些患者是通过使用国家癌症数据库确定的。评估了两个队列：接受彻底放疗 (≥59.4 Gy) 的患者 (n = 5023) 和接受彻底放化疗的患者 (n = 18,206)。放化疗进一步定义为同步（放疗和化疗在彼此相隔 30 天内开始）或序贯（放疗开始 > 化疗后 30 天）。我们通过在倾向评分匹配（PSM）前后使用 Kaplan-Meier 方法和 Cox 比例风险回归比较了治疗组之间的 OS。结果：在 PSM 之前（风险比 [HR] = 0.66，95% 置信区间 [CI]：0.64–0.68，p < 0.001）和 PSM 之后（HR = 0.67， 95% CI：0.64–0.70，p < 0.001）。相对于同步放化疗，序贯放化疗可使死亡风险降低 9%（HR = 0.91，95% CI：0.85–0.96，p = 0.002）。结论：我们发现，与老年患者的确定性放疗相比，确定性放化疗具有生存优势。序贯化疗和放疗优于同步放化疗。尽管需要前瞻性试验，但该分析表明，应强烈考虑对老年患者进行放化疗，而对于该患者群体而言，化疗和放疗的最佳顺序仍然是一个悬而未决的问题。