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Older patients with inoperable non-small cell lung cancer

Long-term survival after concurrent chemoradiotherapy

Ältere Patienten mit inoperablem nicht-kleinzelligem Bronchialkarzinom

Langzeitüberleben nach simultaner Chemoradiotherapie

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Abstract

Purpose

Considering the various comorbidities associated with aging, the feasibility and usefulness of concurrent chemoradiotherapy (CRT) in older patients with inoperable non-small cell lung cancer (NSCLC) is a controversial issue. Here, we compared the feasibility of CRT and the effects of various comorbidities on the prognosis of a minimally selected population of inoperable NSCLC patients aged 60–77 years.

Patients and methods

The study comprised 161 patients with inoperable NSCLC who received CRT with a target radiation dose greater than  60 Gy and platinum-based chemotherapy from 1998 to 2007. The total population included 69 patients aged 60–69 years and 53 aged 70–77 years. These two age cohorts were included in the study with a follow-up of a median 14.5 months.

Results

The two groups showed no differences in long-term survival, as reflected by the 5-year survival rates of 13.0 ± 4.1 % (60- to 69-year-olds) and 14.4 ± 4.9 % (70- to 77-year-olds). During the treatment phase, the groups were comparable in terms of toxicity and the feasibility of chemotherapy. Compared to patients in their 60s, the septuagenarians had more pulmonary comorbidities (p = 0.02), diabetes mellitus (p = 0.04), cardiac comorbidities (p = 0.08), and previous cancer disease (p = 0.08) that exerted a negative effect on survival. In patients without comorbidities, there were no differences between the age groups.

Conclusion

Age is not a contraindication for concurrent CRT per se, because elderly patients do not have a worse long-term prognosis than younger seniors. However, “elderly patients” (≥ 70–77 years) have more concomitant diseases associated with shorter survival than “moderately aged patients” (≥ 60–69 years).

Zusammenfassung

Ziel

Hinsichtlich der verschiedenen altersbedingten Komorbiditäten werden die Durchführbarkeit und der Nutzen einer simultanen Chemoradiotherapie ("concurrent chemoradiotherapy", CRT) bei alten Patienten mit einem inoperablen nicht-kleinzelligem Bronchialkarzinom (NSCLC) kontrovers diskutiert. An einem wenig selektionierten Patientengut wurden die Therapiedurchführbarkeit und der Einfluss der Komorbidität auf die Prognose der NSCLC-Patienten zwischen 60- und 77-Jährigen verglichen

Patienten und Methoden

Im Zeitraum von 1998 bis 2007 erhielten 161 Patienten eine RCT mit einer Zieldosis > 60 Gy und einer platinhaltigen Kombinationschemotherapie. Davon waren 69 Patienten zwischen 60 und69 Jahren und 53 Patienten zwischen 70 und77 Jahren alt. Diese beiden Altersgruppen gingen mit einer medianen Nachbeobachtungszeit von 14,5 Monaten in die Untersuchungen ein. Die.

Ergebnisse

Es fanden sich keine Unterschiede im Langzeitüberleben (nach 5 Jahren für 60-bis 69-Jährige: 13,0 ± 4,1 %, für 70- bis 77-Jährige 14,4 ± 4,9 %. Während der Behandlungsphase waren die Toxizität und die Durchführbarkeit der Chemotherapie vergleichbar. Im höheren Patientenalter hatten die kardiale (p = 0,08) und pulmonale (p = 0,02) Begleitmorbidität, ein Diabetes mellitus (p = 0,04) und eine frühere Karzinomerkrankung (p = 0,08) negative Auswirkungen auf das Überleben im Vergleich zu den 60-Jährigen. Bei Patienten ohne entsprechende Begleiterkrankung fanden sich keine Unterschiede zwischen den Altersgruppen.

Schlussfolgerung

Das Alter für sich stellt keine Kontraindikation für eine simultane RCT dar, da verglichen mit jüngeren Senioren keine schlechtere Langzeitprognose besteht. Jedoch weisen "alte Patienten" (≥ 70–77 Jahre) im Vergleich zu "mittelalten Patienten" (≥ 60–69 Jahre) mehrBegleiterkrankungen auf, die mit einem kürzeren Überleben assoziiert sind.

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Compliance with ethical guidelines

Conflict of interest

S. Semrau and R. Fietkau state that travel expenses and lecture fees were reimbursed in the scope of the German Intergroup Lung Cancer Trial Chemo-Radio-Therapy 1 (GILT-CRT1), which was supported by the Pierre Fabre Group. Otherwise, the authors have no financial or personal interests or relations with the manufacturers of the products used in this study or with their competitors. H. Zett, G. Hildebrandt, and G. Klautke state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Authors and Affiliations

  1. Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany

    Sabine Semrau MD & Rainer Fietkau MD, PhD

  2. Rostock Cancer Registry University of Rostock, Rostock, Germany

    Heike Zettl MD

  3. Department of Radiation Therapy, University of Rostock, Rostock, Germany

    Guido Hildebrandt MD, PhD

  4. Department of Radiation Therapy, Klinikum Chemnitz, Chemnitz, Germany

    Gunther Klautke MD

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  1. Sabine Semrau MD
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  2. Heike Zettl MD
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  3. Guido Hildebrandt MD, PhD
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  4. Gunther Klautke MD
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  5. Rainer Fietkau MD, PhD
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Correspondence to Sabine Semrau MD.

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Semrau, S., Zettl, H., Hildebrandt, G. et al. Older patients with inoperable non-small cell lung cancer. Strahlenther Onkol 190, 1125–1132 (2014). https://doi.org/10.1007/s00066-014-0710-5

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  • DOI: https://doi.org/10.1007/s00066-014-0710-5

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