The Outcome of Combined-Modality Therapy for Stage III Non–Small-Cell Lung Cancer in the Elderly

Abstract

Purpose: The North Central Cancer Treatment Group performed a phase III trial to determine whether chemotherapy plus either bid radiation therapy (RT) or daily (qd) RT resulted in a better outcome for patients with stage III nonsmall-cell lung cancer (NSCLC). No difference in survival was identified between the two arms. This secondary analysis was performed to examine the relationship between patient age and outcome.Patients and Methods: Two hundred forty-six patients were randomized to receive etoposide plus cisplatin and either RT qd or split-course RT bid. This retrospective study compared the outcomes of patients aged >70 years ("elderly patients") with those of younger individuals. Of the 244 assessable patients, 63 (26%) were elderly, and 181 (74%) were younger individuals.Results: The 2-year and 5-year survival rates were 39% and 18%, respectively, in patients younger than 70 years, compared with 36% and 13%, respectively, in elderly patients (P ‫؍‬ .4). Grade 4؉ toxicity occurred in 62% of patients younger than 70 years compared with 81% of elderly patients (P ‫؍‬ .007). Grade 4؉ hematologic toxicity occurred in 56% of patients younger than 70 years, compared with 78% of elderly patients (P ‫؍‬ .003). Grade 4؉ pneumonitis occurred in 1% of those younger than 70 years, compared with 6% of elderly patients (P ‫؍‬ .02).Conclusion: Toxicity, especially myelosuppression and pneumonitis, was more pronounced in the elderly patients receiving combined-modality therapy for locally advanced NSCLC. Despite increased toxicity, elderly patients have survival rates equivalent to younger individuals. Therefore, fit, elderly patients with locally advanced NSCLC should be encouraged to receive combined-modality therapy, preferably on clinical trials with cautious, judicious monitoring. Future studies should explore ways to decrease toxicity of therapy in elderly patients.

Treatment Compliance and Outcome in Geriatric Patients with Locally Advanced Non-Small Cell Lung Cancer: Experience from India

“…These findings were similar to the results of retrospective analyses of a number of randomized trials that have compared outcomes of chemoradiation between elderly patients and their younger counterparts (17,18). Several other studies have also reported efficacy and feasibility of combined modality therapy in elderly population and demonstrated equivalent survival in compliant patients compared to the younger population (7,19,20).…”

Weekly administration of paclitaxel and carboplatin with concurrent thoracic radiation in previously untreated elderly patients with locally advanced non-small-cell lung cancer: A case series of 20 patients

“…The results of age-based retrospective subgroup analyses of randomized phase III trials that evaluated concurrent chemoradiotherapy were previously reported by 5 studies (18)(19)(20)(21)(22). Those studies reported that healthy older adults with locally advanced NSCLC benefitted from concurrent chemoradiotherapy similar to younger patients, but experienced higher rates of hospitalization and toxicity.…”

Cisplatin-based chemotherapy in elderly patients with advanced stage (IIIB and IV) non-small cell lung cancer patients

“…There was also a trend toward shorter median survival in the older group (8.6 vs 6.9 months) and the survival rate was somewhat higher in the younger group (40% vs 30%) [9]. The previously repoted articles suggest that concurrent chemotherapy plus radiotherapy is both tolerable and beneficial in elderly patients with stage III non-small cell lung cancer who are in good overall physical condition [12].…”