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Role of prophylactic cranial irradiation for elderly patients with limited-disease small-cell lung cancer: inverse probability of treatment weighting using propensity score.

ABSTRACT: Studies of prophylactic cranial irradiation (PCI) focused on elderly patients with small-cell lung cancer (SCLC) are rarely conducted. We aimed to identify whether there is a survival benefit of prophylactic cranial irradiation (PCI) in elderly patients using a single institution's retrospective data. A total of 234 patients with limited-disease SCLC (LD-SCLC) treated with thoracic chemoradiotherapy were evaluated; of these, 139 patients received PCI. To minimize treatment selection bias, patients were adjusted using the propensity score on factors associated with receipt of PCI. Cox proportional hazard model and Kaplan-Meier analyses were used to identify which subgroup may benefit from PCI. Median follow-up time was 22 months (range 1-150 months). PCI was associated with favorable brain metastasis-free survival, disease-specific survival, and overall survival in the entire population [hazard ratios (HR) 0.588, 95% confidence interval (CI) 0.338-1.024, P = 0.060; HR 0.477, 95% CI 0.331-0.687, P < 0.001; HR 0.543, 95% CI 0.383-0.771, P = 0.001, respectively). However, PCI had no significant relationship with overall survival in patients aged ?65 years with cT3-4 disease and/or females gender (HR 0.817, 95% CI 0.098-6.849, P = 0.853; HR 1.082, 95% CI 0.114-10.227, P = 0.946, respectively). The benefits and risks of PCI in elderly patients with LD-SCLC need to be scrutinized, especially in those with high T stage tumors and/or females.

SUBMITTER: Kim TG

PROVIDER: S-EPMC6805975 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Role of prophylactic cranial irradiation for elderly patients with limited-disease small-cell lung cancer: inverse probability of treatment weighting using propensity score.

Kim Tae Gyu TG Pyo Hongryull H Ahn Yong Chan YC Noh Jae Myoung JM Oh Dongryul D

Journal of radiation research 20191001 5

Studies of prophylactic cranial irradiation (PCI) focused on elderly patients with small-cell lung cancer (SCLC) are rarely conducted. We aimed to identify whether there is a survival benefit of prophylactic cranial irradiation (PCI) in elderly patients using a single institution's retrospective data. A total of 234 patients with limited-disease SCLC (LD-SCLC) treated with thoracic chemoradiotherapy were evaluated; of these, 139 patients received PCI. To minimize treatment selection bias, patien ...[more]

PMID: 31165148

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Project description:BACKGROUND:It is important to estimate the treatment effect of interest accurately and precisely within the analysis of randomised controlled trials. One way to increase precision in the estimate and thus improve the power for randomised trials with continuous outcomes is through adjustment for pre-specified prognostic baseline covariates. Typically covariate adjustment is conducted using regression analysis, however recently, Inverse Probability of Treatment Weighting (IPTW) using the propensity score has been proposed as an alternative method. For a continuous outcome it has been shown that the IPTW estimator has the same large sample statistical properties as that obtained via analysis of covariance. However the performance of IPTW has not been explored for smaller population trials (<?100 participants), where precise estimation of the treatment effect has potential for greater impact than in larger samples. METHODS:In this paper we explore the performance of the baseline adjusted treatment effect estimated using IPTW in smaller population trial settings. To do so we present a simulation study including a number of different trial scenarios with sample sizes ranging from 40 to 200 and adjustment for up to 6 covariates. We also re-analyse a paediatric eczema trial that includes 60 children. RESULTS:In the simulation study the performance of the IPTW variance estimator was sub-optimal with smaller sample sizes. The coverage of 95% CI's was marginally below 95% for sample sizes <?150 and???100. For sample sizes <?100 the coverage of 95% CI's was always significantly below 95% for all covariate settings. The minimum coverage obtained with IPTW was 89% with n?=?40. In comparison, regression adjustment always resulted in 95% coverage. The analysis of the eczema trial confirmed discrepancies between the IPTW and regression estimators in a real life small population setting. CONCLUSIONS:The IPTW variance estimator does not perform so well with small samples. Thus we caution against the use of IPTW in small sample settings when the sample size is less than 150 and particularly when sample size <?100.

Dataset Information

Role of prophylactic cranial irradiation for elderly patients with limited-disease small-cell lung cancer: inverse probability of treatment weighting using propensity score.

Publications

Role of prophylactic cranial irradiation for elderly patients with limited-disease small-cell lung cancer: inverse probability of treatment weighting using propensity score.

Similar Datasets

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