Modern Radiation Further Improves Survival in Non-Small Cell Lung Cancer: An Analysis of 288,670 Patients

Background: Radiation therapy plays an increasingly important role in the treatment of patients with non-small-cell lung cancer (NSCLC). The purpose of the present study is to assess the survival outcomes of radiotherapy treatment compared to other treatment modalities and to determine the potential role of advanced technologies in radiotherapy on improving survival. Methods: We used cancer incidence and survival data from the Surveillance, Epidemiology, and End Results database linked to U.S. Census data to compare survival outcomes of 288,670 patients with stage I-IV NSCLC treated between 1999 and 2008. The primary endpoint was overall survival. Results: Among the 288,670 patients diagnosed with stage I-IV NSCLC, 92,374 (32%) patients received radiotherapy-almost double the number receiving surgery (51,961, 18%). Compared to other treatment groups and across all stages of NSCLC, patients treated with radiotherapy showed greater median and overall survival than patients without radiation treatment (p < 0.0001). Radiotherapy had effectively improved overall survival regardless of age, gender, and histological categorization. Radiotherapy treatment received during the recent time period 2004 - 2008 is correlated with enhanced survival compared to the earlier time period 1999 - 2003. Conclusion: Radiation therapy was correlated with increased overall survival for all patients with primary NSCLC across stages. Combined surgery and radiotherapy treatment also correlates with improved survival, signaling the value of bimodal or multimodal treatments. Population-based increases in overall survival were seen in the recent time period, suggesting the potential role of advanced radiotherapeutic technologies in enhancing survival outcomes for lung cancer patients

Trends in Ductus Arteriosus Stent Versus Blalock‐Taussig‐Thomas Shunt Use and Comparison of Cost, Length of Stay, and Short‐Term Outcomes in Neonates With Ductal‐Dependent Pulmonary Blood Flow: An Observational Study Using the Pediatric Health Information Systems Database

Background The modified Blalock‐Taussig‐Thomas shunt is the gold standard palliation for securing pulmonary blood flow in infants with ductal‐dependent pulmonary blood flow. Recently, the ductus arteriosus stent (DAS) has become a viable alternative. Methods and Results This was a retrospective multicenter study of neonates ≤30 days undergoing DAS or Blalock‐Taussig‐Thomas shunt placement between January 1, 2017 and December 31, 2020 at hospitals reporting to the Pediatric Health Information Systems database. We performed generalized linear mixed‐effects modeling to evaluate trends in intervention and intercenter variation, propensity score adjustment and inverse probability weighting with linear mixed‐effects modeling to analyze length of stay and cost of hospitalization, and generalized linear mixed modeling to analyze differences in 30‐day outcomes. There were 1874 subjects (58% male, 61% White) from 45 centers (29% DAS). Odds of DAS increased with time (odds ratio [OR] 1.23, annually, P<0.01 [95% CI, 1.10–1.38]) with significant intercenter variation (median OR, 3.81 [95% CI, 2.74–5.91]). DAS was associated with shorter hospital length of stay (ratio of geometric means, 0.76 [95% CI, 0.63–0.91]), shorter intensive care unit length of stay (ratio of geometric means, 0.77 [95% CI, 0.61–0.97]), and less expensive hospitalization (ratio of geometric means, 0.70 [95% CI, 0.56–0.87]). Intervention was not significantly associated with odds of 30‐day transplant‐free survival (OR,1.18 [95% CI, 0.70–1.99]) or freedom from catheter reintervention (OR, 1.02 [95% CI, 0.65–1.58]), but DAS was associated with 30‐day freedom from composite adverse outcome (OR, 1.51 [95% CI, 1.11–2.05]). Conclusions Use of DAS is increasing, but there is variability across centers. Though odds of transplant‐free survival and reintervention were not significantly different after DAS, and DAS was associated with shorter length of stay and lower in‐hospital costs