Chemoradiotherapy Improved Survival in Older Patients With Stage 2 NSCLC

Chemoradiotherapy (CRT) was preferred to radiotherapy alone in patients older than 65 years who had stage II nonsurgical non–small cell lung cancer (NSCLC), as overall survival (OS) and cancer-specific survival (CSS) were both improved in those who used chemoradiotherapy, according to a new study.¹

NSCLC is the most common form of lung cancer, which is the most common cause of cancer-related death.^2,3 Treating NSCLC in the early stages is vital to giving the best prognosis and has become easier with more advanced technologies. Surgery is the top method of treating NSCLC in its early stages but can be difficult on older patients. Stereotactic body radiation therapy (SBRT) is a first-line treatment for nonsurgical NSCLC, but CRT is also an option. This study aimed to assess the efficacy of CRT compared with radiotherapy (RT) alone in older patients with stage II NSCLC that cannot be treated with surgery.

The Surveillance, Epidemiology, and End Results database from the National Cancer Institute was used for this study. Patients were included if they had stage IIA or IIB NSCLC, were 65 years or older at diagnosis, had histologic classification by coding, were not treated surgically, and were diagnosed between 2010 and 2017. Patients who had multiple primary tumors or did not have recorded survival months were not included.

Time from treatment to last follow-up or death by any cause was used to assess OS, whereas CSS was defined by the time between treatment and the last follow-up or death by lung cancer specifically. Age, sex, race, marital status, tumor grade, year of diagnosis, primary tumor site, tumor stage, and node stage were all collected from the participants.

There were 2646 participants in the study, of whom 1307 were in the CRT group and 1339 were in the RT group. There were no statistically significant differences in race, year of diagnosis, laterality, or CSS between the 2 groups, but age, sex, marital status, grade, primary site, and survival months were significantly different in the unmatched groups. The propensity score matching left the study with 1746 patients.

The median (range) follow-up time was 17 (0-119) months. The CRT group had better OS compared with the RT group, with a median OS of 20 months (95% CI, 19-21) vs 16 months (95% CI, 15-17), respectively. The OS rates after 3 and 5 years were 29.3% and 16.8% in the CRT group compared with 23.4% and 11.2% in the RT group. The CSS was similar in the 2 groups, with 3- and 5-year rates of 35.3% and 25.0% in the CRT group compared with 33.3% and 22.4% in the RT group.

There were some limitations to this study. Comorbidity burden was not a factor that was adjusted for in this analysis. Concurrent and sequential CRT were not differentiated in the analysis. The radiation technique was not coded in the database, and SBRT cases could not be removed. Patients receiving RT were often older and had more comorbidities, which were not controlled for and could affect the results.

The researchers concluded that CRT was associated with small improvements in OS and CSS compared with RT alone in patients 65 years and older. However, they cautioned about interpreting the results due to the limitations. “More prospective, randomized clinical trials will be needed for verification of survival benefit and to identify patient subgroups to more appropriately apply this treatment modality,” they wrote.

References

1. Zhang L, Xu X, Gao Y. Study of non-surgical therapeutic patterns and prognosis in elderly patients with stage II non-small-cell lung cancer: an investigational study based on the SEER database. Transl Cancer Res. 2025;14(10):6907-6918. doi:10.21037/tcr-2025-639

2. Non-small cell lung cancer. Cleveland Clinic. Updated January 16, 2025. Accessed November 14, 2025. https://my.clevelandclinic.org/health/diseases/6203-non-small-cell-lung-cancer

3. Key statistics for lung cancer. American Cancer Society. Updated January 16, 2025. Accessed November 14, 2025. https://www.cancer.org/cancer/types/lung-cancer/about/key-statistics.html