Chemoradiotherapy shows Promise for Older Patients with Non-Small Cell Lung Cancer
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A new study suggests that combining chemotherapy with radiation therapy (chemoradiotherapy, or CRT) may improve survival rates for patients over 65 diagnosed with stage II non-small cell lung cancer (NSCLC) who are not candidates for surgery. The research, published in Translational Cancer Research in October 2025, indicates modest gains in both overall survival (OS) and cancer-specific survival (CSS) with CRT compared too radiotherapy (RT) alone.
Lung Cancer: A Persistent Public Health Challenge
Non-small cell lung cancer (NSCLC) remains the most common form of lung cancer and a leading cause of cancer-related deaths worldwide. According to the American Cancer Society, early detection and treatment are crucial for improving prognosis, and advancements in technology are continually refining treatment options. While surgery is frequently enough the preferred approach for early-stage NSCLC, it can pose significant challenges for older patients.
CRT as an Alternative for Older Adults
The study focused on evaluating the effectiveness of CRT versus RT alone in older individuals with stage II NSCLC who could not undergo surgical intervention. Researchers utilized data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database, analyzing records of 2,646 patients diagnosed between 2010 and 2017. To ensure a comparable analysis, the researchers employed a technique called propensity score matching, ultimately refining the study group to 1,746 patients.
Patients included in the study had either stage IIA or IIB NSCLC, were 65 years or older at the time of diagnosis, and had a confirmed histological classification. Those with multiple primary tumors or incomplete survival data were excluded. The primary endpoints of the study were overall survival – defined as time from treatment to death from any cause – and cancer-specific survival, measuring time from treatment to death specifically from lung cancer.
Key Findings: Modest Improvements in Survival
The analysis revealed that the CRT group experienced a statistically significant improvement in median overall survival, reaching 20 months compared to 16 months in the RT group (95% CI, 19-21 vs. 15-17).After three and five years, the OS rates were 29.3% and 16.8% in the CRT group, versus 23.4% and 11.2% in the RT group, respectively.
While cancer-specific survival rates were numerically higher in the CRT group, the difference was not statistically significant. Specifically, 3- and 5-year CSS rates were 35.3% and 25.0% in the CRT group, compared to 33.3% and 22.4% in the RT group.
Study Limitations and Future Directions
The researchers acknowledged several limitations that warrant cautious interpretation of the findings. A critical factor was the lack of data on patients’ comorbidity burden – the presence of other health conditions – which could influence treatment outcomes. Moreover, the analysis did not differentiate between concurrent and sequential CRT approaches. The SEER database also lacked detailed information on the specific radiation techniques used, making it impossible to exclude cases treated with stereotactic body radiation therapy (SBRT), a frequently used first-line treatment for nonsurgical NSCLC.
“Patients receiving RT were frequently enough older and had more comorbidities, which were not controlled for and could affect the results,” one analyst noted.
The study authors concluded that CRT was associated with small improvements in OS and CSS compared with RT alone in patients 65 years and older. Though, they emphasized the need for further examination. “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.
This research underscores the ongoing need for personalized treatment strategies in NSCLC, particularly for older adults, and highlights the importance of considering individual patient characteristics and comorbidities when making treatment decisions.
