Stage III Non-Small Cell Lung Cancer in the elderly: Patient characteristics predictive for tolerance and survival of chemoradiation in daily clinical practice

Driessen, Elisabeth J.M.; Bootsma, G.; Hendriks, Lizza; Berkmortel, Franchette W P J van den; Bogaarts, Brigitte A.H.A.; Loon, Judith G.M. van; Dingemans, Anne‐Marie C.; Janssen‐Heijnen, M.L.G.

doi:10.1016/j.radonc.2016.07.025

Cited by 48 publications

(63 citation statements)

References 35 publications

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“…Non-small-cell lung cancer (NSCLC) represents over 80% of all lung cancer cases, of which up to 35% are locally advanced disease defined as stage III based on the American Joint Committee on Cancer (AJCC) 7th edition. For unresectable or medically inoperable stage III disease, concurrent chemoradiotherapy (CCRT) is considered a standard treatment; however, radiotherapy (RT) alone can be an alternative option [1]. Although the median age of patients newly diagnosed with NSCLC is 70 years old [2], the current evidence for a standard treatment regimen is mainly based on relatively fit and non-geriatric patients [1].…”

Section: Introductionmentioning

confidence: 99%

“…For unresectable or medically inoperable stage III disease, concurrent chemoradiotherapy (CCRT) is considered a standard treatment; however, radiotherapy (RT) alone can be an alternative option [1]. Although the median age of patients newly diagnosed with NSCLC is 70 years old [2], the current evidence for a standard treatment regimen is mainly based on relatively fit and non-geriatric patients [1]. In addition, patients with NSCLC older than 70 years generally have a poor performance status and concomitant comorbidities; thus, the treatment goals for them should take into consideration not only cancer control but also treatment tolerance and quality of life.…”

Section: Introductionmentioning

confidence: 99%

“…A recent update from long-term follow-up published in 2017 revealed CCRT showed the survival benefits without increasing the late toxicity compared to RT alone [3,4]. However, a multicenter retrospective study from the Netherlands Cancer Registry revealed no differences in survival among treatments with CCRT, sequential chemoradiotherapy, and RT alone [1]. On the other hand, a meta-analysis by a Canadian study group found that improved OS was associated with CCRT compared with RT alone [5].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…A significant proportion of locally-advanced non-small cell lung cancer (NSCLC) patients are ineligible for standard of care radical treatment. Recommendations suggest 6-7 weeks of concurrent chemoradiotherapy [1,2], but due to competing comorbidities, logistic issues associated with daily attendance over many weeks and the toxic nature of treatment, almost half of patients do not receive curative treatment [3][4][5] and up to 21% receive no treatment whatsoever [6,7]. The situation was similar for early-stage NSCLC patients until the advent of stereotactic body radiotherapy (SBRT).…”

Section: Introductionmentioning

confidence: 99%

Contrast enhanced oesophageal avoidance for stereotactic body radiotherapy: Barium vs. Gastrografin

Woodford

Panettieri

Ruben

et al. 2019

Technical Innovations & Patient Support in Radiation Oncolo

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Introduction: SABR may facilitate treatment in a greater proportion of locally-advanced NSCLC patients, just as it has for early-stage disease. The oesophagus is one of the key dose-limiting organs and visualization during IGRT would better ensure toxicity is avoided. As the oesophagus is poorly seen on CBCT, we assessed the extent to which this is improved using two oral contrast agents. Materials & methods: Six patients receiving radiotherapy for Stage I-III NSCLC were assigned to receive 50 mL Gastrografin or 50 mL barium sulphate prior to simulation and pre-treatment CBCTs. Three additional patients who did not receive contrast were included as a control group. Oesophageal visibility was determined by assessing concordance between six experienced observers in contouring the organ. 36 datasets and 216 contours were analysed. A STAPLE contour was created and compared to each individual contour. Descriptive statistics were used and a Kappa statistic, Dice Coefficient and Hausdorff distance were calculated and compared using a t-test. Contrast-induced artefact was assessed by observer scoring. Results: Both contrast agents significantly improved the consistency of oesophagus localisation on CBCT across all comparison metrics compared to CBCTs without contrast. Barium performed significantly better than Gastrografin with improved kappa statistics (p = 0.007), dice coefficients (p < 0.001) and Hausdorff distances (p = 0.002), although at a cost of increased image artefact. Discussion: Barium produced lower delineation uncertainties but more image artefact, compared to Gastrografin and no contrast. It is feasible to use oral contrast as a tool in IGRT to help guide clinicians and therapists with online matching and monitoring of the oesophageal position.

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“…These cohort studies demonstrate that elderly patients with stage III NSCLC are less likely to receive standard curative treatments compared to younger patients. CRT for stage III NSCLC, particularly CCRT, can result in severe acute morbidities including esophagitis, hematologic toxicity, and pneumonitis, particularly in elderly patients [ 4 , 9 – 11 , 13 , 22 – 27 ]. Furthermore, CCRT is associated with ~ 2% risk of treatment-related acute mortality in contemporary phase III trials [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Identifying patterns of care for elderly patients with non-surgically treated stage III non-small cell lung cancer: an analysis of the national cancer database

et al. 2018

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BackgroundTo compare patterns of care for elderly patients versus non-elderly patients with non-surgically treated stage III non-small cell lung cancer (NSCLC) using the National Cancer Database (NCDB). We hypothesize that elderly patients are less likely to receive curative treatments, including concurrent chemoradiation (CCRT), compared to non-elderly patients.MethodsWe identified patients from the NCDB between 2003 and 2014 with non-surgically treated stage III NSCLC. We defined elderly as ≥70 years old and non-elderly <70 years old. Treatment categories included: no treatment, palliative treatment (chemotherapy alone, radiation (RT) alone <59.4 Gy or chemoradiation (CRT) <59.4 Gy), or definitive treatment (RT alone ≥59.4 Gy or CRT ≥59.4 Gy). Differences in treatment between elderly and non-elderly were tested using the χ2 test.ResultsWe identified 57,602 elderly and 55,928 non-elderly patients. More elderly patients received no treatment (24.5% vs. 13.2%, P < 0.0001) and the elderly were less likely to receive definitive treatment (48.5% vs. 56.3%, P < 0.0001). CCRT was delivered in a significantly smaller proportion of elderly vs. non-elderly patients (66.0% vs. 78.9%, P < 0.0001 in patients treated with definitive intent; 32.0% vs. 44.5%, P < 0.0001 in patients receiving any treatment; and 24.2% vs. 38.6%, P < 0.0001 amongst all patients).ConclusionsIn this large study of patients with non-surgically treated stage III NSCLC, elderly patients were less likely to receive any treatment or treatment with definitive intent compared to the non-elderly. The lack of use of concurrent or sequential chemotherapy in the elderly with stage III NSCLC suggests that the optimal treatment approach for this vulnerable population remains undefined.Electronic supplementary materialThe online version of this article (10.1186/s13014-018-1142-7) contains supplementary material, which is available to authorized users.

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Stage III Non-Small Cell Lung Cancer in the elderly: Patient characteristics predictive for tolerance and survival of chemoradiation in daily clinical practice

Abstract: Although relatively fit elderly were assigned to cCHRT, treatment tolerance was worse, especially for those with severe comorbidity. Survival seemed not significantly better as compared to sCHRT or RT. Prospective studies in this vital and understudied area are needed.

Cited by 48 publications

References 35 publications

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

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

Contrast enhanced oesophageal avoidance for stereotactic body radiotherapy: Barium vs. Gastrografin

Identifying patterns of care for elderly patients with non-surgically treated stage III non-small cell lung cancer: an analysis of the national cancer database

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