Radiation After Lung Cancer Surgery Doesn't Help All: Study
MONDAY Feb. 13, 2012 -- For older people with a certain type and stage of lung cancer, administering radiation treatment after surgery may not extend survival, according to a new study.
Radiation is not without risks, and the new study "questions the benefit of this treatment," said study leader Dr. Juan Wisnivesky, an associate professor of medicine at Mount Sinai School of Medicine in New York City.
He and his team looked at survival outcomes in more than 1,300 lung cancer patients with locally advanced disease, 710 of whom got the postoperative radiation therapy. It is routinely given in an attempt to prevent recurrence.
No substantial survival benefits were found at one year or three years.
"We found in this group of elderly patients, many of whom received the treatment, the use of the treatment did not appear to help them live longer," he said.
Patients in the study, all 65 or older, had stage 3 non-small cell lung cancer and involvement of N2 lymph nodes. Their cancer had spread but not widely. All had been diagnosed from 1992 through 2005 and were included in the U.S. Surveillance, Epidemiology, and End Results database, which is linked to Medicare.
The study, published online Feb. 13 in the journal Cancer, was funded by the U.S. National Cancer Institute.
About 226,000 new cases of lung cancer will be diagnosed in the United States this year, 90 percent of which will be non-small cell, according to the American Cancer Society. Within non-small cell cancers, there are three main subtypes.
Previous studies looking into the survival benefits of post-op radiation for this group of patients have produced mixed results, Wisnivesky said.
However, in his study, he found no substantial differences between those who had the treatment and those who didn't. And, radiation therapy carries risks. Besides the inconvenience of the additional treatments, the therapy can cause irritation of the lungs and inflammation of the esophagus, he said.
"Patients need to be well informed," he said. "They have to have a good discussion with their doctor about what are the potential benefits," he said. They also need to discuss possible side effects.
Another expert, Dr. Dan Raz, an assistant professor of surgery at City of Hope Comprehensive Cancer Center in Duarte, Calif., emphasized that the study is not talking about all stage 3 lung cancer patients, but only a specific group, those with stage 3 non-small cell and involvement of the N2 lymph nodes.
"It's a small subset of patients" of all lung cancer patients, he said, adding that it's a challenging group.
Some previous small studies have also suggested that post-op radiation may be unnecessary in these patients, and the new findings add to that argument, he said.
"In the end, survival and quality of life are the most important things for patients," Raz said. But recurrence, a key factor, was not addressed in the study, he said.
The new finding "wouldn't change the way I treat patients, but I think it raises a very important point."
What's needed is a trial comparing use of post-operative radiation and its non-use in this group of patients, Raz said. According to Wisnivesky, such a study is under way in France, but will take several years to finish.
For more on radiation therapy, go to the American Cancer Society.
Posted: February 2012
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