DOI QR코드

DOI QR Code

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

  • Kang, Ki Mun (Department of Radiation Oncology, Gyeongsang National University School of Medicine) ;
  • Jeong, Bae Kwon (Department of Radiation Oncology, Gyeongsang National University School of Medicine) ;
  • Ha, In Bong (Department of Radiation Oncology, Gyeongsang National University School of Medicine) ;
  • Chai, Gyu Young (Department of Radiation Oncology, Gyeongsang National University School of Medicine) ;
  • Lee, Gyeong Won (Institute of Health Science, Gyeongsang National University School of Medicine) ;
  • Kim, Hoon Gu (Institute of Health Science, Gyeongsang National University School of Medicine) ;
  • Kang, Jung Hoon (Institute of Health Science, Gyeongsang National University School of Medicine) ;
  • Lee, Won Seob (Institute of Health Science, Gyeongsang National University School of Medicine) ;
  • Kang, Myoung Hee (Institute of Health Science, Gyeongsang National University School of Medicine)
  • Received : 2012.07.20
  • Accepted : 2012.09.24
  • Published : 2012.09.30

Abstract

Purpose: Combined 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 Methods: Among 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. Results: Regarding 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. Conclusion: The 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.

Keywords

References

  1. Gridelli C, Perrone F, Monfardini S. Lung cancer in the elderly. Eur J Cancer 1997;33:2313-4. https://doi.org/10.1016/S0959-8049(97)10050-8
  2. Havlik RJ, Yancik R, Long S, Ries L, Edwards B. The National Institute on Aging and the National Cancer Institute SEER collaborative study on comorbidity and early diagnosis of cancer in the elderly. Cancer 1994;74:2101-6. https://doi.org/10.1002/1097-0142(19941001)74:7+<2101::AID-CNCR2820741718>3.0.CO;2-M
  3. Gridelli C, Massarelli E, Maione P, et al. Potential role of molecularly targeted therapy in the management of advanced nonsmall cell lung carcinoma in the elderly. Cancer 2004; 101:1733-44. https://doi.org/10.1002/cncr.20572
  4. Casas F, Kepka L, Agarwal JP, et al. Radiochemotherapy in the elderly with lung cancer. Expert Rev Anticancer Ther 2009;9:1405-11. https://doi.org/10.1586/era.09.110
  5. Talarico L, Chen G, Pazdur R. Enrollment of elderly patients in clinical trials for cancer drug registration: a 7-year experience by the US Food and Drug Administration. J Clin Oncol 2004;22:4626-31. https://doi.org/10.1200/JCO.2004.02.175
  6. Curran WJ Jr, Paulus R, Langer CJ, et al. Sequential vs. concurrent chemoradiation for stage III non-small cell lung cancer: randomized phase III trial RTOG 9410. J Natl Cancer Inst 2011;103:1452-60. https://doi.org/10.1093/jnci/djr325
  7. Zatloukal P, Petruzelka L, Zemanova M, et al. Concurrent versus sequential chemoradiotherapy with cisplatin and vinorelbine in locally advanced non-small cell lung cancer: a randomized study. Lung Cancer 2004;46:87-98. https://doi.org/10.1016/j.lungcan.2004.03.004
  8. Gridelli C, Maione P, Rossi A, et al. Treatment of advanced non-small-cell lung cancer in the elderly. Lung Cancer 2009;66:282-6. https://doi.org/10.1016/j.lungcan.2009.08.006
  9. Atagi S, Kawahara M, Yokoyama A, et al. Thoracic radiotherapy with or without daily low-dose carboplatin in elderly patients with non-small-cell lung cancer: a randomised, controlled, phase 3 trial by the Japan Clinical Oncology Group (JCOG0301). Lancet Oncol 2012;13:671-8. https://doi.org/10.1016/S1470-2045(12)70139-0
  10. Lau DH, Crowley JJ, Gandara DR, et al. Southwest Oncology Group phase II trial of concurrent carboplatin, etoposide, and radiation for poor-risk stage III non-small-cell lung cancer. J Clin Oncol 1998;16:3078-81. https://doi.org/10.1200/JCO.1998.16.9.3078
  11. Davidoff AJ, Gardner JF, Seal B, Edelman MJ. Populationbased estimates of survival benefi t associated with combined modality therapy in elderly patients with locally advanced non-small cell lung cancer. J Thorac Oncol 2011;6:934-41. https://doi.org/10.1097/JTO.0b013e31820eed00
  12. Kang KM, Lee GW, Kim HG, Kang JH, Lee WS, Chai GY. Paclitaxel and cisplatin with induction chemotherapy followed by concurrent chemoradiotherapy for stage IIIB non-small cell lung cancer. J Korean Soc Ther Radiol Oncol 2006;24:223-9.
  13. Hayakawa K, Mitsuhashi N, Katano S, et al. High-dose radiation therapy for elderly patients with inoperable or unresectable non-small cell lung cancer. Lung Cancer 2001;32:81-8. https://doi.org/10.1016/S0169-5002(00)00219-1
  14. Movsas B, Scott C, Sause W, et al. The benefit of treatment intensification is age and histology-dependent in patients with locally advanced non-small cell lung cancer (NSCLC): a quality-adjusted survival analysis of radiation therapy oncology group (RTOG) chemoradiation studies. Int J Radiat Oncol Biol Phys 1999;45:1143-9. https://doi.org/10.1016/S0360-3016(99)00325-9
  15. Werner-Wasik M, Scott C, Cox JD, et al. Recursive partitioning analysis of 1999 Radiation Therapy Oncology Group (RTOG) patients with locally-advanced non-small-cell lung cancer (LA-NSCLC): identification of five groups with different survival. Int J Radiat Oncol Biol Phys 2000;48:1475-82. https://doi.org/10.1016/S0360-3016(00)00801-4
  16. Schild SE, Stella PJ, Geyer SM, et al. The outcome of combinedmodality therapy for stage III non-small-cell lung cancer in the elderly. J Clin Oncol 2003;21:3201-6. https://doi.org/10.1200/JCO.2003.12.019

Cited by

  1. Non-small cell lung cancer therapy: safety and efficacy in the elderly vol.5, pp.None, 2012, https://doi.org/10.2147/dhps.s41199
  2. Changes in non-surgical management of stage III non-small cell lung cancer at a single institution between 2003 and 2010 vol.53, pp.3, 2014, https://doi.org/10.3109/0284186x.2013.819995
  3. Definitive radiotherapy alone over 60 Gy for patients unfit for combined treatment to stage II-III non-small cell lung cancer: retrospective analysis vol.10, pp.None, 2015, https://doi.org/10.1186/s13014-015-0560-z
  4. Radical Oncological Surgery and Adjuvan Therapy in Non-Small Cell Lung Cancer Patients over 70 years of Age vol.16, pp.11, 2012, https://doi.org/10.7314/apjcp.2015.16.11.4711
  5. Distinctive Patterns of Initially Presenting Metastases and Clinical Outcomes According to the Histological Subtypes in Stage IV Non-Small Cell Lung Cancer vol.95, pp.6, 2016, https://doi.org/10.1097/md.0000000000002795
  6. Normal lung sparing Tomotherapy technique in stage III lung cancer vol.12, pp.None, 2012, https://doi.org/10.1186/s13014-017-0905-x