A population-based study of the diagnosis to treatment interval and overall survival for stage I non-small cell lung cancer treated with stereotactic body radiation therapy
Jul 2026· McMaster University Medical Journal· 0 citations
TL;DR
The findings suggest that efforts to shorten DTI may improve patient survival in this population of patients with stage I non-adenocarcinoma NSCLC treated with SBRT in Ontario.
Abstract
Background: Lung cancer is one of the most diagnosed cancers and the leading cause of cancer-related deaths in Ontario. For patients with medically inoperable stage I non-small cell lung cancer (NSCLC), stereotactic body radiation therapy (SBRT) is recommended. However, there is limited evidence on how the diagnosis to treatment interval (DTI) impacts survival, which is relevant to inform health policy and improve patient outcomes.
Objective: To investigate the association between DTI and survival for patients with stage I non-adenocarcinoma NSCLC treated with SBRT in Ontario.
Methods: We conducted a population-based retrospective cohort study using linked ICES health administrative datasets, applying recently published international consensus-based methodology recommendations for investigating the association between cancer DTI and overall survival (OS). The cohort included Ontario patients with stage I NSCLC diagnosed between January 1, 2010, and June 30, 2019, treated with curative SBRT. Patients with adenocarcinomas were excluded because of histological diversity uncontrollable within the available data. A 5 month from diagnosis landmark time was used to limit immortal time bias and the wait time paradox. Kaplan Meier analysis was used to visualize survival. Multivariable Cox proportional hazards models were used to assess the association between DTI and OS and cancer-specific survival (CSS), adjusting for relevant factors.
Results: The cohort included 532 patients with a median DTI of 61 (interquartile range: 46-79) days. Kaplan Meier analysis suggested longer DTIs were associated with worse OS. In adjusted Cox models, each 1-week (aHR=1.04 (95% CI=1.01–1.08)), and 4-week (aHR=1.19 (95% CI=1.03–1.38)) increase in DTI was associated with worse OS. Similarly, each 1-week (aHR=1.05 (95% CI=1.01–1.10)), and 4-week (aHR=1.22 (95% CI=1.03–1.45)) increase in DTI was associated with worse CSS. Findings remained robust in sensitivity analyses.
Conclusions: Our findings suggest that efforts to shorten DTI may improve patient survival in this population.
It was found that prolonged DTIs to be significantly associated with poorer survival, but cautious interpretation of the results is needed given the potential impact of the waiting time paradox.
M. Jalink, W. King, Christopher M. Booth et al.· Cancer Epidemiology· 0 citations
Background Survival benefit of thoracic radiotherapy (TRT) in patients with stage IV non-small cell lung cancer (NSCLC) receiving first-line chemo-immunotherapy remains uncertain. This study developed and validated an overall survival (OS) prediction model and assessed whether TRT benefit varied across risk strata. Methods Patients with stage IV NSCLC treated with first-line chemo-immunotherapy were enrolled. A nomogram was developed using baseline clinical variables to calculate individual risk scores. Patients were classified into high- and low-risk groups according to the median nomogram-derived score. OS was compared between ICI and ICI+TRT groups in the overall cohort and risk subgroups. Treatment-by-risk interaction, 1:1 propensity score matching (PSM), treatment response, TRT pattern, BED10, and metastatic burden subgroup analyses, and safety assessments were performed. Results Among 514 patients, 284 without TRT were assigned to training and internal validation cohorts at a 7:3 ratio, and 84 non-TRT patients formed an external validation cohort. ECOG performance status, alkaline phosphatase, total protein, platelet-to-lymphocyte ratio, and systemic immune-inflammation index were selected as optimal prognostic factors. The nomogram showed good 1- and 2-year OS discrimination, calibration, and clinical utility. Using a median risk score of 103.1, TRT improved OS only in low-risk patients (HR 0.456, 95% CI 0.285–0.730; P = 0.0011), not high-risk patients (HR 0.914, 95% CI 0.556–1.503; P = 0.7239), with consistent findings after PSM. Treatment-by-risk interaction was significant (P = 0.0309). Grade 1–2 pneumonitis was higher with ICI+TRT than ICI alone (28.8% vs. 10.3%; P < 0.001), without significant differences in severe pneumonitis or immune-related adverse events. Conclusion TRT benefit was risk-dependent, improving OS in low-risk but not high-risk patients.
Jia-Xing Guo, G. Ji, Jiao Zhang et al.· Frontiers in Oncology· 0 citations
Background For early-stage cervical cancer, surgery constitutes the standard therapeutic approach. Whether adjuvant radiotherapy and chemotherapy should be administered to patients with intermediate- or high-risk pathological characteristics continues to generate debate. Controversy persists regarding the ideal postoperative adjuvant treatment approach for this patient population. Using the Surveillance, Epidemiology, and End Results (SEER) database, this study compared survival outcomes among early-stage cervical cancer patients managed with observation, postoperative radiotherapy (PORT), or postoperative concurrent chemoradiotherapy (POCRT). Methods Patients with stage I–II cervical cancer who underwent surgical treatment from 2004 to 2020 were identified through the SEER database. Patients were classified into three cohorts based on their postoperative management: observation, PORT, and POCRT. Overall survival (OS) and cancer-specific survival (CSS) were assessed through Cox proportional hazards regression, competing risk modeling, Kaplan-Meier survival curves, and subgroup analyses. Results Among 13,687 eligible patients, 9,868 underwent postoperative observation, 1,237 received PORT, and 2,582 received POCRT. In the unmatched overall cohort, patients receiving adjuvant therapy had higher mortality rates and higher-risk baseline profiles. Stratified analysis demonstrated that postoperative observation was associated with better survival than PORT and POCRT in stage I patients (P<0.001), whereas POCRT was associated with better survival compared with observation and PORT in stage II patients (P=0.04). Subgroup analyses suggested associations between postoperative adjuvant therapy and better survival among patients with T2 disease, N1 status, multiple primary malignancies (≥2), or age ≥60 years. Conclusions For patients with early-stage cervical cancer, the decision regarding PORT and chemotherapy should remain guided by current guideline-based risk stratification. Our findings suggest that tumor (T) stage, node (N) stage, multiple primary malignancies, and age warrant further investigation as potential effect modifiers.
Chang Weng, Yan Wang, Wen-B. Chen et al.· Translational Cancer Researc...· 0 citations
OBJECTIVE
For patients with recurrence after chemotherapy for extensive-stage small cell lung cancer (SCLC), the length of the chemotherapy-free interval (CFI) may guide the choice of second-line treatment. However, evidence supporting specific CFI thresholds is limited. We investigated the influence of the CFI on the effectiveness of second-line treatment in SCLC patients.
METHODS
Patients diagnosed with SCLC in 2022 were selected from the Netherlands Cancer Registry. Cox regression and parametric survival models were used to investigate the association between the type of second-line treatment, the CFI, progression-free survival (PFS) and overall survival (OS). Analyses were adjusted for age, sex, performance status, income, comorbidities, response to first-line treatment, and distant metastases.
RESULTS
261 patients were included: 79 received (30.3%) topotecan, 153 (58.6%) platinum rechallenge, and 29 (11.1%) another systemic treatment. Median PFS was 2.0 and 3.9 months after topotecan and platinum rechallenge, respectively. Median OS was 3.8 and 5.6 months, respectively. Multivariable analyses showed a lower risk of progression for patients with a CFI of 90-179 days receiving platinum rechallenge vs topotecan (hazard ratio (HR): 0.62, 95% confidence interval (95%CI): 0.40-0.95), without a difference in OS (HR: 0.99, 95%CI: 0.65-1.52). Parametric survival models confirmed these results.
CONCLUSIONS
For patients with a CFI exceeding 90 days, platinum rechallenge represents a rational second-line treatment strategy. These results remain relevant despite the introduction of first-line chemoimmunotherapy, as a substantial proportion of patients still relapse within 180 days. They are also relevant for healthcare settings where immunotherapy access remains limited or unavailable.
A. Eijkelboom, B. Peters, D. Dumoulin et al.· Lung Cancer· 0 citations
OBJECTIVE
Surveillance imaging for non-small cell lung cancer (NSCLC) survivors may reduce mortality from recurrence and secondary primary tumors, but survival impact is difficult to assess due to confounding from symptom-driven imaging. We evaluated the association between active surveillance adherence (ASA) and survival in a longitudinal cohort.
METHODS
Patients with Stage I-III NSCLC who received curative-intent therapy and survived >6 months were identified within the Veterans Health Administration (2008-2016). Active surveillance adherence (ASA) was defined using contemporaneous NCCN guidelines and clinical chart abstraction. Time-to-event analysis incorporated time-varying ASA exposure, modeled as a continuous variable and as a percentage of time elapsed, with adjustment for clinical characteristics. Subgroup analysis was performed among patients with recurrence. Time to recurrence and post-recurrence survival were compared to evaluate potential lead-time bias.
RESULTS
The cohort included 5650 patients; predominantly White (73%), male (97%) with Stage I disease (54%) treated with Surgery alone (52%). ASA was associated with a reduced risk of death, (HR 0.92 per 6 months [95%CI 0.89-0.95, p<0.001]). Symptom- driven imaging was not associated with reduced risk of death (HR 1.05 per 6 months [1.00 -1.11, p=0.066]). In patients with recurrence (N=2199) median overall survival from treatment was 34 months [33, 36] for surveillance-detected vs 27 months [24, 30] for symptom-detected, p<0.0001. Time to recurrence did not differ significantly.
CONCLUSIONS
ASA was associated with significant survival benefit compared to symptom-driven imaging which is not explained by lead-time bias, contrasting with prior reports failing to demonstrate benefits of surveillance following treatment for lung cancer.
Amanda V. Immidisetti, Nicole Lin, Julie T Wu et al.· Journal of Thoracic and Card...· 0 citations
Background: Laryngeal cancer is one of the most common malignancies of the upper aerodigestive tract. Its management relies on surgery, radiotherapy, chemotherapy, or combined treatment modalities according to tumor stage. Although current therapeutic strategies have improved locoregional control and organ preservation, treatment-related toxicity remains a major clinical concern, particularly among patients with locally advanced disease. This study aimed to evaluate the association between tumor stage and treatment-related toxicity in patients treated for laryngeal cancer at the National Institute of Oncology in Rabat. Methods: We conducted a retrospective cohort study including patients with histologically confirmed laryngeal cancer treated at the Department of Radiation Oncology of the National Institute of Oncology, Rabat, between January 2022 and January 2024. Clinical, tumor-related, treatment-related, and toxicity data were collected from medical records. Tumor stage was determined according to the TNM classification, and patients were categorized into two groups: early-stage disease and locally advanced disease. Acute and late toxicities were assessed using the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. The association between tumor stage and treatment-related toxicity was analyzed using comparative statistical tests. Results: A total of 127 patients were included. The median age was 56 years, with a marked male predominance. Most patients presented with locally advanced disease at diagnosis.
F. Chakib, I. Lahlou, A. Lachgar et al.· SAS Journal of Medicine· 0 citations
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