Concurrent chemoradiotherapy for elderly patients with stage III non-small cell lung cancer

Abstract

PurposeCombined chemoradiotherapy is standard management for locally advanced non-small cell lung cancer (LA-NSCLC), but standard treatment for elderly patients with LA-NSCLC has not been confirmed yet. We evaluated the feasibility and efficacy of concurrent chemoradiotherapy (CCRT) for elderly patients with LA-NSCLC.Materials and MethodsAmong patients older than 65 years with LA-NSCLC, 36 patients, who underwent CCRT were retrospectively analyzed. Chemotherapy was administered 3-5 times with 4 weeks interval during radiotherapy. Thoracic radiotherapy was delivered to the primary mass and regional lymph nodes. Total dose of 54-59.4 Gy (median, 59.4 Gy) in daily 1.8 Gy fractions and 5 fractions per week.ResultsRegarding the response to treatment, complete response, partial response, and no response were shown in 16.7%, 66.7%, and 13.9%, respectively. The 1- and 2-year overall survival (OS) rates were 58.2% and 31.2%, respectively, and the median survival was 15 months. The 1- and 2-year progression-free survivals (PFS) were 41.2% and 19.5%, respectively, and the median PFS was 10 months. Regarding to the toxicity developed after CCRT, pneumonitis and esophagitis with grade 3 or higher were observed in 13.9% (5 patients) and 11.1% (4 patients), respectively. Treatment-related death was not observed.ConclusionThe treatment-related toxicity as esophagitis and pneumonitis were noticeably lower when was compared with the previously reported results, and the survival rate was higher than radiotherapy alone. The results indicate that CCRT is an effective in terms of survival and treatment related toxicity for elderly patients over 65 years old with LA-NSCLC.

How Do Elderly Poor Prognosis Patients Tolerate Palliative Concurrent Chemoradiotherapy for Locally Advanced Non–Small-Cell Lung Cancer Stage III? A Subset Analysis From a Clinical Phase III Trial

“…The difference in hospital admissions related to side effects was most prominent among the patients aged 70 years, possibly owing to the dose-reduced chemotherapy in this age group. Nevertheless, the rate of esophagitis and hematologic toxicity among the elderly were in accordance with the findings from Kang et al 34 They reported an incidence of treatment-related toxicity in the elderly that was noticeably lower than previously reported. 34 We should expect that more modern planning techniques and radiologic equipment will help to reduce the radiologic effects on the esophagus and bone marrow in the future.…”

Radiotherapy Dose and Induction Chemotherapy Cycles Are Associated With Prognosis and Toxicity Risk: A Retrospective Study of 227 Patients With Unresectable Stage III Non-Small-Cell Lung Cancer

“…In clinical practice, not all patients are eligible for aggressive or radical treatment, especially elderly patients, 13 , 14 and treatment for those patients usually remains conservative. 8 , 15 In Driessen’s research, all patients received a minimum total tumor dose of 54 Gy.…”

Definitive radiotherapy alone over 60 Gy for patients unfit for combined treatment to stage II-III non-small cell lung cancer: retrospective analysis

“…Hence, it has been argued that fit, elderly patients with locally advanced NSCLC should receive a combined-modality therapy with cautious and judicious monitoring [ 6 , 11 ]. Growing evidence supports that aggressive treatment will have benefit in survival, even in elderly NSCLC patients [ 11 – 14 ]. But, it is obvious that elderly patients are generally not treated using a combined-modality therapy.…”