A review of the management of elderly patients with non-small-cell lung cancer

Abstract

Most patients with non-small-cell lung cancer (NSCLC) are elderly but evidence to guide appropriate treatment decisions for this age group is generally scant. Careful evaluation of the elderly should be undertaken to ensure that treatment appropriate for the stage of the tumour is guided by patient characteristics and not by age. The Comprehensive Geriatric Assessment (CGA) remains the preferred option, but briefer tools may be appropriate to select patients for further evaluation. The predicted outcome should be used to guide management decisions together with a reappraisal of polypharmacy. Patient expectations should also be taken into account. Management recommendations are generally similar to those of general guidelines for the NSCLC population, although the risks of surgery and toxicity of chemotherapy and radiotherapy are often increased in the elderly compared with younger patients; therefore, patients should be closely scrutinised and subjected to a CGA to ensure suitability of the planned treatment. If surgery is indicated, then lobectomy is generally the preferred option, although limited resection may be more feasible for some. Radiotherapy with curative intent is an alternative, with stereotactic body radiotherapy the most likely preferred modality. Adjuvant chemotherapy is also an appropriate approach, whereas adjuvant radiotherapy is generally not recommended. Concurrent chemoradiotherapy should be considered for elderly patients with inoperable locally advanced disease and chemotherapy for advanced/metastatic disease. Efforts should also be made to increase participation of elderly patients with NSCLC in clinical trials, thereby enhancing evidence-based treatment decisions for this majority group. This will require overcoming barriers relating to trial design and to physician and patient awareness and attitudes.

How Should Palliative Thoracic Radiotherapy Be Fractionated for Octogenarians with Lung Cancer?

“…Median actuarial survival was 3.4 months and 20% of the in vivo 32: 331-336 (2018) 332 RT: Radiotherapy, ITT: intention to treat, TV: target volume. 1 Missing information in some cases; 2 <11.7 g/dl (females) and <13.4 g/dl (males), institutional lower limit of normal; 3 institutional upper limit of normal.…”

“…Octogenarians with lung cancer are not a homogeneous patient population (1)(2)(3)(4). While many patients present with a long history of smoking and considerable pulmonary and cardiovascular comorbidity, often compromising activities of daily living, others are physically active and well functioning.…”

Lung carcinoma patients aged eighty years over and prognostic factors affecting survival

“…Çeşitli çalışmalarda tek başına yaşın cerrahi tedavi için kontrendike olmadığı, ayrıca yaşın sağkalım üzerine negatif prognostik faktör olmadığı bildirilmiştir (18)(19)(20) Olgularımızın ortanca sağkalım süresi 2.73 ay olup, literatürdeki diğer çalışmalarla uyumludur (4,7,10,11). Çalışmamızda sigara içme hikayesi olan, nefes darlığı olan, histopatolojik olarak küçük hücre-li kanser olguları, ileri evre ve semptomatik tedavi verilen olguların yaşam süreleri diğerlerine göre daha kısa bulundu.…”

“…Seksen yaş ve üzeri akciğer kanseri olgularında yaş mortalite ilişkisini gösteren sınırlı sayıda araştırma mevcuttur (2)(3)(4). Yaşlı kanser hastalarına tıbbi rutin yaklaşımlar konusunda sorunlar yaşanmaktadır.…”

Stereotactic body radiotherapy (SBRT) for the treatment of inoperable stage I non-small cell lung cancer patients

“…Individual evaluation is especially relevant for choosing the best treatment. However, recent evidence has shown that chronological age did not determine the final decision regarding the therapeutic modality [12]. The main medical problems identified among the patients enrolled in the trials reflected in these articles included were: chronic obstructive pulmonary disease (COPD), baseline forced expiratory volume in the first second of expiration (FEV1) lower than 40 %, reduced predicted postoperative FEV1, reduced diffusing capacity of lung carbon monoxide (DLCO), baseline hypoxemia and/or hypercapnia, chronic heart failure, and diabetes mellitus with severe organ damage and severe cerebral disease.…”