Abstract
Combined chemoradiation (CRT) is the standard therapy in locally advanced non-small cell lung cancer (NSCLC). Nevertheless, the best approach in the elderly population is still poorly defined. We retrospectively reviewed the charts of elderly (≥65 years) patients with unresectable, locally advanced NSCLC, diagnosed at the Brazilian National Cancer Institute between 2003 and 2007. The primary outcome was overall survival (OS), measured from diagnosis until death. Palliative therapy (PT) included best supportive care radiation therapy (RT; ≤40 Gy) and palliative chemotherapy. Among patients treated with radical RT, OS was measured from date of treatment beginning until death (OST). One hundred seventy-one patients were included, with median age of 71 years (range 65–90). Thirty-nine percent received PT, 32 % exclusive RT (>40 Gy), and 29 % CRT (concomitant or sequential). Patients treated with RT and CRT had better OS (median 13.7 months [95 % CI 10.9–16.4] and 15.5 months [95 % CI 13.0–17.9]) than PT (median 4.1 months [95 % CI 3.6–4.6]; p < 0.0001). In the multivariate analysis, RT (HR 0.28 [95 % CI 0.18–0.42]; p < 0.0001) and CRT (HR 0.17 [95 % CI 0.1–0.27]; p < 0.0001) were independently correlated to better survival in comparison with PT. Among patients receiving radical RT, the addition of chemotherapy was correlated to longer OST (median 13.8 [95 % CI 10.6–17.0] vs. 10.8 months [95 % CI 8.6–13.1]; p = 0.018). This benefit was confirmed in the multivariate analysis (HR 0.59 [95 % CI 0.36–0.97]; p = 0.039). Elderly patients with locally advanced NSCLC derived significant survival benefit from radical RT and CRT, suggesting that age should not be a contraindication for these aggressive therapeutic strategies.
Similar content being viewed by others
References
Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.
Aupérin A, Le Péchoux C, Pignon JP, et al. Concomitant radio-chemotherapy based on platin compounds in patients with locally advanced non-small cell lung cancer (NSCLC): a meta-analysis of individual data from 1764 patients. Ann Oncol. 2006;17:473–83.
Auperin A, Le Péchoux C, Rolland E, et al. Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol. 2010;28(13):2181–90.
Schild SE, Stella PJ, Geyer SM, et al. The outcome of combined-modality therapy for stage III non-small-cell lung cancer in the elderly. J Clin Oncol. 2003;21:3201–6.
Langer CJ, Hsu C, Curran WJ, et al. Elderly patients (pts) with local advanced non-small cell lung cancer (LA-NSCLC) benefit from combined modality therapy: Secondary analysis of Radiation Therapy Oncology Group (RTOG) 94-10. Proc Am Soc Clin Oncol. 2002;21:75s (abstr 1193).
Okamoto H, Atagi S, Kawahara M, et al. Updated results of a phase III trial comparing standard thoracic radiotherapy (RT) with or without concurrent daily low-dose carboplatin in elderly patients (pts) with locally advanced non-small cell lung cancer (NSCLC): JCOG0301. J Clin Oncol. 2012;30 (suppl; abstr 7017).
Ries LAG, Melbert D, Krapcho M, et al. SEER cancer statistics review, 1975–2005. Bethesda: National Cancer Institute; 2007. Available at: http://seer.cancer.gov/csr/1975_2005/. Accessed 15 April 2012.
Kaplan EL, Meier P. Nonparametric estimation for incomplete observation. J Am Stat Assoc. 1958;53:457–81.
Lawless JS. Statistical models and methods for life-time data. New York: Wiley; 1982.
Cox DR. Regression models and life tables. J R Stat Soc. 1972;34:187–220.
Davidoff AJ, Gardner JF, Seal B, et al. Population-based estimates of survival benefit associated with combined modality therapy in elderly patients with locally advanced non-small cell lung cancer. J Thorac Oncol. 2011;6(5):934–41.
Coate LE, Massey C, Hope A, et al. Treatment of the elderly when cure is the goal: the influence of age on treatment selection and efficacy for stage III non-small cell lung cancer. J Thorac Oncol. 2011;6(3):537–44.
Quoix E, Zalcman G, Oster JP, et al. Carboplatin and weekly paclitaxel doublet chemotherapy compared with monotherapy in elderly patients with advanced non-small-cell lung cancer: IFCT-0501 randomised, phase 3 trial. Lancet. 2011;378(9796):1079–88.
Cavalcanti L, Kutwak F, Ruiz AL, et al. Outcomes of combined modality treatment in elderly patients with stage III non-small cell lung cancer. J Clin Oncol. 2012;30 (suppl; abstr 7049).
Conflict of interest
The authors declare no conflicts of interest related to this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Domingues, P.M., Zylberberg, R., da Matta de Castro, T. et al. Survival data in elderly patients with locally advanced non-small cell lung cancer. Med Oncol 30, 449 (2013). https://doi.org/10.1007/s12032-012-0449-8
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s12032-012-0449-8