The Outcome of Combined-Modality Therapy for Stage III Non–Small-Cell Lung Cancer in the Elderly
- 1 September 2003
- journal article
- clinical trial
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 21 (17), 3201-3206
- https://doi.org/10.1200/jco.2003.12.019
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 non–small-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.Keywords
This publication has 20 references indexed in Scilit:
- Cancer Statistics, 2002CA: A Cancer Journal for Clinicians, 2002
- Therapy choices among older patients with lung carcinomaCancer, 2001
- Do elderly patients (pts) with locally advanced non-small cell lung cancer (NSCLC) benefit from combined modality therapy? a secondary analysis of RTOG 94-10International Journal of Radiation Oncology*Biology*Physics, 2001
- Sequential vs. concurrent chemotherapy and radiation therapy for inoperable non-small cell lung cancer (NSCLC): Analysis of failures in a phase III study (RTOG 9410)International Journal of Radiation Oncology*Biology*Physics, 2000
- Effect of advanced age on outcome in Radiation Therapy Oncology Group studies of locally advanced NSCLC (LA-NSCLC)Lung Cancer, 2000
- Improved Survival in Stage III Non-Small-Cell Lung Cancer: Seven-Year Follow-up of Cancer and Leukemia Group B (CALGB) 8433 TrialJNCI Journal of the National Cancer Institute, 1996
- Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trialsBMJ, 1995
- Radiotherapy alone versus combined chemotherapy and radiotherapy in unresectable non-small cell lung carcinomaLung Cancer, 1994
- Radiotherapy as an alternative to surgery in elderly patients with resectable lung cancerRadiotherapy and Oncology, 1988
- Nonparametric Estimation from Incomplete ObservationsJournal of the American Statistical Association, 1958