PORT may not prolong life in older people with NSCLC

Researchers from Mount Sinai School of Medicine have found that post-operative radiation therapy (PORT), a controversial yet frequently administered treatment for lung cancer, may not prolong life in older people with locally advanced disease. The findings appear in the February 13 online edition of CANCER, a peer-reviewed journal of the American Cancer Society.

In patients with non-small cell lung cancer (NSCLC), the standard of care is surgery to remove the tumor. However, in patients with stage III disease and involvement of a type of lymph node called N2, clinicians will often prescribe a course of PORT to improve outcomes.

"While some analyses have shown improvement with PORT, the data are not strong enough to support using it as a standard of care in older adults with this type of lung cancer," said Juan Wisnivesky, MD, DrPH, Vice-Chair for Research in the Department of Medicine at Mount Sinai School of Medicine and lead author on the study. "Our results show that we need more information about the potential benefits of radiation therapy before it is used routinely to treat these patients, especially considering the side effects associated with it."

The research team identified 1,307 cases of stage III NSCLC with N2 lymph node involvement between 1992 and 2005 using the Surveillance, Epidemiology and End Results (SEER)-Medicare registry, which links cancer incidence and survival data to a master file of Medicare records. Overall, 710, or 54 percent, of these patients aged 66 and up received PORT after their tumor was removed. The researchers found that one-year and three-year survival was not improved in the group receiving PORT compared to the group that did not receive it. The researchers concluded that use of PORT should be limited until definitive data is available.

"Our study indicates that clinicians should refrain from widespread use of PORT in elderly patients with this cancer subtype until we know more," said Dr. Wisnivesky. "A randomized and controlled trial is required to fully assess any benefit, and such trials are ongoing now."