Compliance and Outcome of Elderly Patients Treated in the Concurrent Once-Daily Versus Twice-Daily Radiotherapy (CONVERT) Trial

Abstract

IntroductionThere is a lack of data on the efficacy and safety of concurrent chemoradiotherapy in elderly, limited-stage, patients with SCLC.MethodsWe compared outcomes of patients 70 years of age or older versus younger patients within the Concurrent Once-daily Versus twice-daily RadioTherapy (CONVERT) trial. Patients were randomized to receive 45 Gy/30 twice-daily fractions/19 days or 66 Gy/33 once-daily fractions/45 days concurrently with platinum-based chemotherapy. Overall survival and progression-free survival were evaluated using Kaplan-Meier methodology and Cox proportional hazards regression.ResultsOf 547 patients randomized between April 2008 and November 2013, 57 did not receive protocol treatment and were excluded. Of the 490 patients included, 67 (14%) were 70 years of age or older (median age: 73 years; range: 70–82). Fewer older patients received the optimal number of radiotherapy fractions (73% versus 85%; p = 0.03); however, chemotherapy compliance was similar in both groups (p = 0.24). Neutropenia grade 3/4 occurred more frequently in the elderly (84% versus 70%; p = 0.02) but rates of neutropenic sepsis (4% versus 7%; p = 0.07) and death (3% versus 1.4%; p = 0.67) were similar in both groups. With a median follow-up of 46 months; median survival in the elderly versus younger groups was 29 (95% confidence interval [CI]: 21–39) versus 30 months (95% CI: 26–35), respectively; (hazard ratio: 1.15, 95% CI: 0.84–1.59; p = 0.38). Median time to progression in the elderly versus younger groups was 18 months (95% CI: 13–31) versus 16 months (95% CI: 14–19), respectively (hazard ratio: 1.04, 95% CI: 0.76–1.41; p = 0.81).ConclusionsConcurrent chemoradiotherapy with modern radiotherapy techniques should be a treatment option for fit, older patients.

Sequential chemotherapy followed by radical thoracic radiotherapy (50 Gy in 25 fractions) in limited stage small cell lung cancer

“…In our series, age was associated with an adverse outcome using 65 years as cut off. This is in contrast to a second analysis of CONVERT study which showed no impact of age using cut of 70 years [20].…”

SEOM clinical guidelines for the treatment of small-cell lung cancer (SCLC) (2019)

“…In LS-SCLC, the concurrent CTRT with modern radiotherapy techniques could be a treatment option for fit, older patients. This approach yields equivalent mOS in older vs younger patients (29 vs 30 months; p = 0.38) [37].…”

Concurrent Chemoradiation in Elderly Patients with Limited-Stage Small Cell Lung Cancer

“…4 Dr. Arjyal urges caution in the use of full-dose chemotherapy in elderly patients because of concerns about the higher risk of chemotherapy-related toxicity. 1 We fully agree with this view and would like to highlight that the suitability of elderly patients with limited-stage (LS) SCLC for chemoradiotherapy should be carefully assessed before treatment by a multidisciplinary team. However, patients should not be denied treatment purely on the basis of their physiological age but offered the treatment best suited to their biological and functional status.…”

“…To the Editor: Christodoulou et al compared outcomes of elderly (70 years of age) and younger patients (<70 years) with once-daily versus twice-daily radiation and concurrent chemotherapy in limited-stage SCLC. 1 The results were encouraging and supported chemoradiotherapy for fit, older patients. The study showed that fewer older patients received the optimal radiation treatments and had a higher rate of grade 3 or 4 neutropenia but the rates of chemotherapy compliance, neutropenic sepsis, and death were similar in both groups.…”

“…Although the study by Christodoulou et al 1 showed a similar rate of chemotherapy compliance between the two groups, we should be very cautious when using full-dose chemotherapy, as we know that elderly patients are at increased risk of severe toxicity from chemotherapy. In their predictive tool model, Hurria et al demonstrated that age 72 years or older is an independent factor predictive of higher-grade toxicity.…”