Chemoradiotherapy versus radiotherapy alone following induction chemotherapy for elderly patients with stage III lung cancer

Abstract

PurposeIt is unclear whether adding concurrent chemotherapy (CT) to definitive radiotherapy (RT) following induction CT is a tolerable and cost effective treatment for non-small-cell lung cancer (NSCLC) patients aged 70 years or older with comorbidities. This study evaluated the actual clinical outcomes between concurrent chemoradiotherapy (CCRT) and RT alone following induction CT or not in patients (≥70 years) in a single institution’s clinical practice.Materials and MethodsA total of 82 patients with unresectable stage III NSCLC between 2004 and 2016 were retrospectively analyzed. Their treatment tolerance and clinical outcomes such as overall survival (OS), locoregional recurrence (LRR), treatment toxicities and distant metastasis (DM) were evaluated. Early mortality rates were also evaluated as 4-month mortality after RT.ResultsFifty-four patients received CCRT and 28 patients received RT alone. Induction CT before RT was performed for 68.5% and 50.0% in CCRT and RT alone groups. Treatment tolerance was significantly worse in CCRT (p = 0.046). The median survival was 21.1 and 18.1 months for CCRT and RT alone, which was not statistically significant. LRR and DM were also not different. Most early deaths after CCRT were attributed to non-cancer-related mortality. Acute esophagitis of grade ≥2 occurred more following CCRT (p = 0.017). In multivariate analysis, a Charlson Comorbidity Index (CCI) of ≥5 and a weight loss of ≥5% after RT were associated with poor OS. The factors adversely affecting 4-month survival were a CCI of ≥5 and CCRT.ConclusionThere were no significant differences in OS, LRR, and DM between CCRT and RT alone treatment in elderly patients. However, there was a poorer tolerance and higher incidence of acute esophagitis in the CCRT group. Specifically, when the patients had a CCI of ≥5, RT alone seems to be reasonable with a low probability of early death.

Prognostic factors for overall survival of stage III non-small cell lung cancer patients on computed tomography: A systematic review and meta-analysis

“…Five publications were considered to have a high and 8 a low relevance, 52 a medium (Appendix Figure C.3, Table C.3). Low relevance was assigned due to a lack of explicit description of patient characteristics in the stage III cohort [32,50,69], or pronounced discrepancies with the standard stage III population [17,[61][62][63]85]. Most studies (n = 62) were estimated to have a medium validity.…”

Undertreatment or overtreatment – how far from each other in geriatric oncology?

“…There are no benefits from chemoradiotherapy preceded by induction chemotherapy in comparison to radiotherapy for those older than 70 years. There were no significant differences in overall survival, local recurrence rate and distant metastases while, there was a poorer tolerance and higher incidence of acute esophagitis in a more intensively treatment group (32).…”

Carbon-ion radiotherapy for octogenarians with locally advanced non-small-cell lung cancer

“…Several studies on photon radiotherapy alone for patients older than 70 years with stage ΙΙΙ LA-NSCLC reported that the median PFS and OS of radiotherapy alone were 6.8 months and 11-18.1 months, respectively [18][19][20][21]. Driessen et al reported a median OS of 5 months when patients older than 70 years with stage ΙΙΙ LA-NSCLC selected non-curative treatment [19].…”

“…Several studies on photon radiotherapy alone for patients older than 70 years with stage ΙΙΙ LA-NSCLC reported that the median PFS and OS of radiotherapy alone were 6.8 months and 11–18.1 months, respectively [ 18 – 21 ]. Driessen et al .…”

“…In addition, sustained disease control is uncommon [ 22 ]. Further, while CRT is effective, it is highly toxic for octogenarians and may worsen quality of life [ 21 ]. Unfortunately, photon radiotherapy alone also yields poor prognosis despite the relatively low incidence of severe toxicity.…”