Hypofractionated versus standard radiation therapy with or without @entity2903 for older @entity463 XXXX .

@entity1 @entity66 @entity2903 @entity2904 @entity463
PURPOSE: Older @entity1 with newly diagnosed @entity463 have poor outcomes, and optimal treatment is controversial. Hypofractionated radiation therapy (HRT) is frequently used but has not been compared to @entity1 receiving standard fractionated radiation therapy (SRT) and @entity2903 ( @entity2904 ). METHODS AND MATERIALS: We conducted a retrospective analysis of @entity1 >= 65 years of age who received radiation for the treatment of newly diagnosed @entity463 from 1994 to 2013. The distribution of clinical covariates across various radiation regimens was analyzed for possible selection bias. Survival was calculated using the Kaplan-Meier method. Comparison of hypofractionated radiation (typically, 40 Gy/15 fractions) versus standard fractionation (typically, 60 Gy/30 fractions) in the setting of @entity2903 was conducted using Cox regression and propensity score analysis. RESULTS: @entity1 received SRT + @entity2904 (n=57), SRT (n=35), HRT + @entity2904 (n=34), or HRT (n=9). @entity1 receiving HRT were significantly older (median: 79 vs 69 years of age; P<.001) and had worse baseline performance status (P<.001) than those receiving SRT. On multivariate analysis, older age (adjusted hazard ratio [AHR]: 1.06; 95% confidence interval [CI]: 1.01-1.10, P=.01), lower Karnofsky performance status (AHR: 1.02; 95% CI: 1.01-1.03; P=.01), @entity66 (AHR: 2.11; 95% CI: 1.23-3.61, P=.007), and radiation alone (vs SRT + @entity2904 ; SRT: AHR: 1.72; 95% CI: 1.06-2.79; P=.03; HRT: AHR: 3.92; 95% CI: 1.44-10.60, P=.007) were associated with decreased overall survival. After propensity score adjustment, @entity1 receiving HRT with @entity2904 had similar overall survival compared with those receiving SRT with @entity2904 (AHR: 1.10, 95% CI: 0.50-2.4, P=.82). CONCLUSIONS: With no randomized data demonstrating equivalence between HRT and SRT in the setting of @entity2904 for @entity463 , significant selection bias exists in the implementation of HRT. Controlling for this bias, we observed similar overall survival for HRT and SRT with concurrent @entity2904 among elderly @entity1 , suggesting the need for a randomized trial to compare these regimens directly.
