Skip to main content

Advertisement

SpringerLink
Log in

Short and mid-term outcomes of multimodal treatment for locally-advanced non-small cell lung cancer in elderly patients

  • Original Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Objective

Multimodality treatments are effective for locally advanced non-small cell lung cancer (LA-NSCLC) showing benefits in overall (OS) and disease-free survival (DFS), but these options are frequently denied to elderly patients.

Methods

The objectives of this retrospective study were: to investigate mortality, morbidity and oncological outcomes of pulmonary resection after induction therapy (IT) for NSCLC in elderly patients. We divided the cohort into two: patients < 70 years (group A) and patients ≥70 years (group B). A multivariable logistic regression was built to identify factors associated with morbidity.

Results

77 patients underwent pulmonary resection after IT, 27 were aged ≥70 years. Type of chemotherapy, surgical procedures, pathological stages were comparable between the two groups, while the preoperative use of chemo-radiation therapy regimen was more frequent in group A (p = 0.027). In-hospital mortality was similar, while the percentage of patients with complications (38% vs 48.1%, p = 0.47) and the complication rate (50% vs 77%, p = 0.01) were higher in group B, but the severity of complications was comparable. The multivariable analysis did not identify any risk factors associated with morbidity. OS at 3 years and DFS at 2 years were not different (61% vs 48.5%, p = 0.64; 61.7% vs 44%, p = 0.393).

Conclusions

Lung resection for LA-NSCLC after IT can be performed safely in selected elderly patients with favourable postoperative and mid-term oncological results.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Rivera C, Jougon J, Dahan M, Falcoz PE, Bernard A, Brouchet L. Are postoperative consequences of neoadjuvant chemotherapy for non-small cell lung cancer more severe in elderly patients? Lung Cancer. 2012;76(2):216–21.

    Article  Google Scholar 

  2. Yang CJ, Mayne NR, Wang H, et al. Outcomes of major lung resection after induction therapy for non-small cell lung cancer in elderly patients. Ann Thorac Surg. 2016;102(3):962–70.

    Article  Google Scholar 

  3. Marquez-Medina D, Martin-Marco A, Ojanguren-Garranz A. Age does not worsen the efficacy nor tolerance to combined induction therapies in locally advanced non-small cell lung cancer. Anticancer Res. 2014;34(8):4373–6.

    PubMed  Google Scholar 

  4. Pallis AG, Gridelli C, Wedding U, Faivre-Finn C, Veronesi G, Jaklitsch M, Luciani A, O'Brien M. Management of elderly patients with NSCLC; updated expert's opinion paper: EORTC Elderly Task Force, Lung Cancer Group and International Society for Geriatric Oncology. Ann Oncol. 2014;25(7):1270–83.

    Article  CAS  Google Scholar 

  5. Browner I, Purtell M. Chemotherapy in the older patient with operable non-small cell lung cancer: neoadjuvant and adjuvant regimens. Thorac Surg Clin. 2009;19(3):377–89.

    Article  Google Scholar 

  6. Detillon DDEMA, Veen EJ. Postoperative outcome after pulmonary surgery for non-small cell lung cancer in elderly patients. Ann Thorac Surg. 2018;105(1):287–93.

    Article  Google Scholar 

  7. Coate LE, Massey C, Hope A, Sacher A, Barrett K, Pierre A, Leighl N, Brade A, de Perrot M, Waddell T, Liu G, Feld R, Burkes R, Cho BC, Darling G, Sun A, Keshavjee S, Bezjak A, Shepherd FA. 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.

    Article  Google Scholar 

  8. Martins RG, D'Amico TA, Loo BW Jr, et al. The management of patients with stage IIIA non-small cell lung cancer with N2 mediastinal node involvement. J Natl Compr Canc Netw. 2012;10:599–613.

    Article  CAS  Google Scholar 

  9. Shah AA, Berry MF, Tzao C, et al. Induction chemoradiation is not superior to induction chemotherapy alone in stage IIIA lung cancer. Ann Thorac Surg. 2012;93:1807–12.

    Article  Google Scholar 

  10. Roth JA, Fossella F, Komaki R, et al. A randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non-small-cell lung cancer. J Natl Cancer Inst. 1994;86:673–80.

    Article  CAS  Google Scholar 

  11. Scagliotti GV, Pastorino U, Vansteenkiste JF, et al. Randomized phase III study of surgery alone or surgery plus preoperative cisplatin and gemcitabine in stages IB to IIIA non-small-cell lung cancer. J Clin Oncol. 2012;30:172–8.

    Article  CAS  Google Scholar 

  12. Song WA, Zhou NK, Wang W, et al. Survival benefit of neoadjuvant chemotherapy in non-small cell lung cancer: an updated meta-analysis of 13 randomized control trials. J Thorac Oncol. 2010;5:510–6.

    Article  Google Scholar 

  13. Blumenthal GM, Bunn PA Jr, Chaft JE, et al. Current status and future perspectives on neoadjuvant therapy in lung cancer. J Thorac Oncol. 2018;13(12):1818–31.

    Article  CAS  Google Scholar 

  14. 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(5):1475–82.

    Article  CAS  Google Scholar 

  15. Albain KS, Swann RS, Rusch VW, et al. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial. Lancet. 2009;374(9687):379–86.

    Article  CAS  Google Scholar 

  16. Chansky K, Detterbeck FC, Nicholson AG, et al. The IASLC Lung Cancer Staging Project: external validation of the revision of the TNM stage groupings in the eighth edition of the TNM classification of lung cancer. J Thorac Oncol. 2017;12(7):1109–21.

    Article  Google Scholar 

  17. National Comprehensive Cancer Network. Non-Small Cell Lung Cancer (Version 5.2018). https://www.nccn.org/

  18. Postmus PE, Kerr KM, Oudkerk M, Senan S, Waller DA, Vansteenkiste J, Escriu C, Peters S. Early-stage and locally advanced (non-metastatic) non-small-cell lung cancer: ESMO clinical practice guidelines. Ann Oncol. 2017;28(suppl 4):1–21.

    Article  Google Scholar 

  19. Hotta K, Ueoka H, Kiura K, Tabata M, Tanimoto M. An overview of 48 elderly-specific clinical trials of systemic chemotherapy for advanced non-small cell lung cancer. Lung Cancer. 2004;46(1):61–766.

    Article  Google Scholar 

  20. Gridelli C, Langer C, Maione P, Rossi A, Schild SE. Lung cancer in the elderly. J Clin Oncol. 2007;25(14):1898–907.

    Article  Google Scholar 

  21. Oken M, Creech R, Tormey D, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5:649–55.

    Article  CAS  Google Scholar 

  22. Asmis TR, Ding K, Seymour L, et al. Age and comorbidity as independent prognostic factors in the treatment of non small-cell lung cancer: a review of National Cancer Institute of Canada Clinical Trials Group trials. J Clin Oncol. 2008;26(1):54–9.

    Article  CAS  Google Scholar 

  23. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  Google Scholar 

  24. Gonfiotti A, Bongiolatti S, Bertolaccini L, et al. Thoracoscopic lobectomy for locally advanced-stage non-small cell lung cancer is a feasible and safe approach: analysis from multi-institutional national database. J Vis Surg. 2017;7(3):160.

    Article  Google Scholar 

  25. Hennon M, Sahai RK, Yendamuri S, Tan W, Demmy TL, Nwogu C. Safety of thoracoscopic lobectomy in locally advanced lung cancer. Ann Surg Oncol. 2011;18(13):3732–6.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Thoracic Surgery Unit, Careggi University Hospital, Largo Brambilla, 1, 50134, Florence, Italy

    Stefano Bongiolatti, Alessandro Gonfiotti, Alberto Salvicchi, Sara Borgianni & Luca Voltolini

  2. Medical Oncology Unit, Careggi University Hospital, Florence, Italy

    Francesca Mazzoni & Giulia Di Pierro

  3. Respiratory Medicine, Careggi University Hospital, Florence, Italy

    Katia Ferrari

Authors
  1. Stefano Bongiolatti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesca Mazzoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alessandro Gonfiotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giulia Di Pierro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alberto Salvicchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sara Borgianni
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Katia Ferrari
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Luca Voltolini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alberto Salvicchi.

Ethics declarations

Conflict of interest

The authors declare that they do not have any conflict of interest.

Ethical approval

This article does not contain any study with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bongiolatti, S., Mazzoni, F., Gonfiotti, A. et al. Short and mid-term outcomes of multimodal treatment for locally-advanced non-small cell lung cancer in elderly patients. Gen Thorac Cardiovasc Surg 68, 1290–1297 (2020). https://doi.org/10.1007/s11748-020-01384-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-020-01384-5

Keywords

Search

Navigation