High-dose radiation therapy for elderly patients with inoperable or unresectable non-small cell lung cancer.
OBJECTIVE
To evaluate definitive radiation therapy delivering doses in excess of 60 Gy for elderly patients aged 75 years or over with non-small cell lung cancer (NSCLC).


METHODS
The treatment results for 97 patients aged 75 years or older (mean age 78 years; elderly group) with inoperable or unresectable NSCLC were retrospectively analyzed and compared with those for 206 patients younger than 75 year old (mean age 64 years; younger group). The elderly patients were classified into two groups; 67 patients aged 75-79 years (the elderly A) and 30 patients aged 80 years or older (the elderly B). Most of all patients were treated with a total dose of 60 Gy or more in 2 Gy daily standard fractionation.


RESULTS
The overall 2 and 5 year survival rates were 32 and 13% for the elderly A group, and 28 and 4% for the elderly B group, respectively, compared with 36 and 12% for the younger group. There was not a statistically significant difference in survival rates among three groups. In stage I-II NSCLC patients there was also no significant difference in survival curves among the three groups. In patients with stage III disease, however, the survival curve of the elderly B was inferior to those of the younger group and the elderly A group, although the difference was not statistically significant. After the treatment the deterioration rate of the performance status was only 5% in the younger group and 8% in the elderly group. Only three younger and two elderly patients died of late pulmonary insufficiency associated with high-dose irradiation to the proximal bronchus. No other treatment-related event was observed except for mild acceptable acute complications in the elderly groups.


CONCLUSIONS
Definitive radiation therapy is recommended to the elderly aged 75 years or older with inoperable or unresectable NSCLC, especially early stage disease, as an acceptable choice of treatment.
Department of Radiology and Radiation Oncology, Gunma University School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma 371-8511, Japan. hayakazu@med.kitasato-u.ac.jp
K
K
Hayakawa
N
N
Mitsuhashi
S
S
Katano
Y
Y
Saito
Y
Y
Nakayama
H
H
Sakurai
T
T
Akimoto
M
M
Hasegawa
M
M
Yamakawa
H
H
Niibe
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011882:Radiotherapy, High-Energy / Q000009:adverse effects; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome