Skip to main content
SpringerLink
Log in

Treatment of Limited-Stage Disease in Older Patients: The Role of Thoracic Radiotherapy and Prophylactic Cranial Irradiation

  • Chapter
  • First Online:
Book cover Management of Lung Cancer in Older People

  • 1082 Accesses

Abstract

Elderly patients should neither be undertreated nor overtreated with RT or CTRT. Treatment selection should not be made on the basis of chronological age and should take into account performance status, stage, comorbidities, nutritional status, and patients’ preference. The benefits of concurrent CTRT have to be ­balanced against the risks of radiation esophagitis and pneumonitis which are more likely to lead to hospitalization, malnutrition, and deterioration of QoL in the elderly compared to their younger counterparts. Future studies in SCLC including elderly patients are urgently needed with emphasis on toxicity, QoL, and efficacy. The use of geriatric assessments may help to define groups of patients more likely to benefit from aggressive treatments such as concurrent CTRT and may also enable more robust stratification of elderly patients in prospective studies. Furthermore, advances in RT planning and delivery, such as omitting elective nodal irradiation, 4-D conformal RT planning, intensity-modulated radiotherapy (IMRT), and image-guided radiotherapy (IGRT), are likely to widen the therapeutic window, and the resulting reduction in toxicity should make future RT more tolerable for elderly patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Owonikoko TK, Ragin CC, Belani CP, et al. Lung cancer in elderly patients: an analysis of the surveillance, epidemiology, and end results database. J Clin Oncol. 2007;25(35):5570–7.

    Article  PubMed  Google Scholar 

  2. Lally BE, Geiger AM, Urbanic JJ, et al. Trends in the outcomes for patients with limited stage small cell lung cancer: an analysis of the Surveillance, Epidemiology, and End Results database. Lung Cancer. 2009;64(2):226–31.

    Article  PubMed  Google Scholar 

  3. Govindan R, Page N, Morgensztern D, et al. Changing epidemiology of small cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database. J Clin Oncol. 2006;24:4539–44.

    Article  PubMed  Google Scholar 

  4. Bayman N, Sheikh H, Kularatne B, et al. Radiotherapy for small-cell lung cancer – where are we heading? Lung Cancer. 2009;63(3):307–14.

    Article  PubMed  CAS  Google Scholar 

  5. Faivre-Finn C, Lorigan P, West C, et al. Thoracic radiation therapy for limited-stage small-cell lung cancer. Unanswered questions. Clin Lung Cancer. 2005;7:23–9.

    Article  PubMed  Google Scholar 

  6. Van Loon J, De Ruysscher D, Wanders R, et al. Selective nodal irradiation on basis of (18)FDG-PET scans in limited disease small-cell lung cancer: a prospective study. Int J Radiat Oncol Biol Phys. 2010;77:329–36.

    Article  PubMed  Google Scholar 

  7. De Ruysscher D, Pijls-Johannesma M, Vansteenkiste J, et al. Systematic review and meta-analysis of randomised, controlled trials of the timing of chest radiotherapy in patients with limited-stage, small-cell lung cancer. Ann Oncol. 2006;17:543–52.

    Article  PubMed  Google Scholar 

  8. Fried DB, Morris DE, Poole C, et al. Systematic review evaluating the timing of thoracic radiation therapy in combined modality therapy for limited-stage small-cell lung cancer. J Clin Oncol. 2004;22:4837–45.

    Article  PubMed  Google Scholar 

  9. Huncharek M, McGarry R. A meta-analysis of the timing of chest irradiation in the combined modality treatment of limited-stage small cell lung cancer. Oncologist. 2004;9:665–72.

    Article  PubMed  Google Scholar 

  10. Turrisi 3rd AT, Kim K, Blum R, et al. Twice daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. N Engl J Med. 1999;340:265–71.

    Article  PubMed  CAS  Google Scholar 

  11. Repetto L, Balducci L. A case for geriatric oncology. Lancet Oncol. 2002;3:289–97.

    Article  PubMed  Google Scholar 

  12. Repetto L, Venturino A, Fratino L, et al. Geriatric oncology: a clinical approach to the older patient with cancer. Eur J Cancer. 2003;39:870–80.

    Article  PubMed  CAS  Google Scholar 

  13. Auperin A, Arrigada R, Pignon J-P, et al. Prophylactic cranial irradiation for patients with small cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group. N Engl J Med. 1999;341:476–84.

    Article  PubMed  CAS  Google Scholar 

  14. Balducci L. Geriatric oncology: challenges for the new century. Eur J Cancer. 2000;36:1741–54.

    Article  PubMed  CAS  Google Scholar 

  15. Pignon JP, Arriagada R, Ihde DC, et al. A meta-analysis of thoracic radiotherapy for small-cell lung cancer. N Engl J Med. 1992;327:1618–24.

    Article  PubMed  CAS  Google Scholar 

  16. Albain KS, Crowley JJ, LeBlanc M, et al. Determinants of improved outcome in small-cell lung cancer: an analysis of the 2,580-patient Southwest Oncology Group data base. J Clin Oncol. 1990;8:1563–74.

    PubMed  CAS  Google Scholar 

  17. Osterlind K, Andersen PK. Prognostic factors in small cell lung cancer: multivariate model based on 778 patients treated with chemotherapy with or without irradiation. Cancer Res. 1986;46:4189–94.

    PubMed  CAS  Google Scholar 

  18. Sagman U, Maki E, Evans WK, et al. Small-cell carcinoma of the lung: derivation of a prognostic staging system. J Clin Oncol. 1991;9:1639–49.

    PubMed  CAS  Google Scholar 

  19. Spiegelman D, Maurer LH, Ware JH, et al. Prognostic factors in small-cell carcinoma of the lung: an analysis of 1,521 patients. J Clin Oncol. 1989;7:344–54.

    PubMed  CAS  Google Scholar 

  20. Fairchild A, Harris K, Barnes E, et al. Palliative thoracic radiotherapy for lung cancer: a systematic review. J Clin Oncol. 2008;26:4001–11.

    Article  PubMed  Google Scholar 

  21. Turner NJ, Muers MF, Haward RA, et al. Do elderly people with lung cancer benefit from palliative radiotherapy? Lung Cancer. 2005;49:193–202.

    Article  PubMed  CAS  Google Scholar 

  22. Faivre-Finn C, Lee LW, Lorigan P, et al. Thoracic radiotherapy for limited-stage small-cell lung cancer: controversies and future developments. Clin Oncol (R Coll Radiol). 2005;17:591–8.

    Article  CAS  Google Scholar 

  23. Ludbrook JJ, Truong PT, MacNeil MV, et al. Do age and comorbidity impact treatment allocation and outcomes in limited stage small-cell lung cancer? A community-based population analysis. Int J Radiat Oncol Biol Phys. 2003;55:1321–30.

    Article  PubMed  Google Scholar 

  24. Janssen-Heijnen ML, Maas HA, Siesling S, et al. Treatment and survival of patients with small-cell lung cancer: small steps forward, but not for patients >80. Ann Oncol. 2012;23(4):954–60.

    Article  PubMed  CAS  Google Scholar 

  25. Yuen AR, Zou G, Turrisi AT, et al. Similar outcome of elderly patients in intergroup trial 0096: cisplatin, etoposide, and thoracic radiotherapy administered once or twice daily in limited stage small cell lung carcinoma. Cancer. 2000;89:1953–60.

    Article  PubMed  CAS  Google Scholar 

  26. Schild SE, Stella PJ, Brooks BJ, et al. Results of combined-modality therapy for limited-stage small cell lung carcinoma in the elderly. Cancer. 2005;103(11):2349–54.

    Article  PubMed  Google Scholar 

  27. Quon H, Shepherd FA, Payne DG, et al. The influence of age on the delivery, tolerance, and efficacy of thoracic irradiation in the combined modality treatment of limited stage small cell lung cancer. Int J Radiat Oncol Biol Phys. 1999;43:39–45.

    Article  PubMed  CAS  Google Scholar 

  28. Yellen SB, Cella DR, Leslie WT. Age and clinical decision making in oncology patients. J Natl Cancer Inst. 1994;86:1766–70.

    Article  PubMed  CAS  Google Scholar 

  29. Murray N, Grafton C, Shah A, et al. Abbreviated treatment for elderly, infirm, or noncompliant patients with limited-stage small-cell lung cancer. J Clin Oncol. 1998;6:3323–8.

    Google Scholar 

  30. Takada M, Fukuoka M, Kawahara M, et al. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limited-stage small-cell lung cancer: results of the Japan Clinical Oncology Group Study 9104. J Clin Oncol. 2002;20:3054–60.

    Article  PubMed  CAS  Google Scholar 

  31. Patel S, Macdonald OK, Suntharalingam M. Evaluation of the use of prophylactic cranial irradiation in small cell lung cancer. Cancer. 2009;115:842–50.

    Article  PubMed  Google Scholar 

  32. Giuliani M, Sun A, Bezjak A, et al. Utilization of prophylactic cranial irradiation in patients with limited stage small cell lung carcinoma. Cancer. 2010;116(24):5694–9.

    Article  PubMed  Google Scholar 

  33. Grosshans DR, Meyers CA, Allen PK, et al. Neurocognitive function in patients with small cell lung cancer: effect of prophylactic cranial irradiation. Cancer. 2008;112(3):589–95.

    Article  PubMed  Google Scholar 

  34. Komaki R, Shin Dong M, Glisson BS, et al. Interdigitating versus concurrent chemotherapy and radiotherapy for limited small cell lung cancer. Int J Radiat Oncol Biol Phys. 1995;31(4):807–11.

    Article  PubMed  CAS  Google Scholar 

  35. Le Péchoux C, Dunant A, Senan S, et al. Standard-dose versus higher-dose prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer in complete remission after chemotherapy and thoracic radiotherapy (PCI 99–01, EORTC 22003–08004, RTOG 0212, and IFCT 99–01): a randomised clinical trial. Lancet Oncol. 2009;10(5):467–74.

    Article  PubMed  Google Scholar 

  36. Arriagada R, Le Chevalier T, Borie F, et al. Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. J Natl Cancer Inst. 1995;87:183–90.

    Article  PubMed  CAS  Google Scholar 

  37. Gregor A, Cull A, Stephens RJ, et al. Prophylactic cranial irradiation is indicated following complete response to induction therapy in small cell lung cancer: results of a multicentre randomised trial. Eur J Cancer. 1997;33:1752–8.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK

    Rovel J. Colaco FRCR, Anna P. Britten MRCP & Corinne Faivre-Finn MD, PhD

  2. Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Rd, Manchester, M20 4BX, UK

    Fiona H. Blackhall PhD, FRCP

Authors
  1. Rovel J. Colaco FRCR
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anna P. Britten MRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fiona H. Blackhall PhD, FRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Corinne Faivre-Finn MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Corinne Faivre-Finn MD, PhD .

Editor information

Editors and Affiliations

  1. , Department of Oncology/Hematology, S.G. Moscati Hospital, Contrada Amoretta, Avellino, 83100, Italy

    Cesare Gridelli

  2. St Helens Teaching Hospital, University of Liverpool, Marshalls Cross Road, St Helens, WA9 3DA, United Kingdom

    Riccardo A Audisio

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag London

About this chapter

Cite this chapter

Colaco, R.J., Britten, A.P., Blackhall, F.H., Faivre-Finn, C. (2013). Treatment of Limited-Stage Disease in Older Patients: The Role of Thoracic Radiotherapy and Prophylactic Cranial Irradiation. In: Gridelli, C., Audisio, R. (eds) Management of Lung Cancer in Older People. Springer, London. https://doi.org/10.1007/978-0-85729-793-8_17

Download citation

  • DOI: https://doi.org/10.1007/978-0-85729-793-8_17

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-0-85729-792-1

  • Online ISBN: 978-0-85729-793-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation