Impact of comorbidity and age on the outcome of patients with inoperable NSCLC treated with concurrent chemoradiotherapy.
BACKGROUND
The value of concurrent chemoradiotherapy (CRT) for treatment of locally advanced non-small cell lung cancer (NSCLC) in elderly and multimorbid patients is generally disputed due to the assumed lack of toxicity compensation or the limited prognosis of the accompanying morbidity.


OBJECTIVE
We investigated correlation between impaired organ function, age, tumor-associated symptoms, social factors and acute toxicity as well as survival following CRT.


METHODS
Retrospective data collection and analysis were performed on the variables age, functional parameters: FEV1, VC, DLCO, LVEF, creatinine clearance, age, several categories of comorbidities, WHO performance status, alcohol and nicotine habits, toxicity according CTC-criteria and survival of all patients (n=66) with inoperable NSCLC suffering substantial comorbidities or advanced age (>70 years) treated with an CRT consisting of two cycles cisplatin or carboplatin plus vinorelbine and a conventionally fractionated radiotherapy up to 63Gy.


RESULTS
Median survival of all patients was 13 months (10.6-15.4 months, 95% confidence interval). Univariate analyses showed significantly poorer survival (12 months vs. 15 months) in patients with LVEF<50% compared with LVEF> or = 50% (P=0.022, in log-rank test). All other variables did not exhibit any significant correlation to survival. Multivariate analyses revealed significantly inferior survival in patients suffering from cardiac or pulmonary dysfunction (P=0.039, hazard ratio [HR]: 2.18; 95% CI of HR [1.04-4.59]). Elderly patients (>70 years) had a higher prevalence of hematotoxicity of higher degree than younger patients (< or = 70 years), but without significant impact on the feasibility of both treatment modalities.


CONCLUSIONS
Our results suggest that cardiac and pulmonary dysfunction may be associated with a reduced survival in elderly or poor-risk patients with inoperable NSCLC after CRT.
Semrau
S
S
Department of Radiotherapy, University of Rostock, Südring 75, 18059 Rostock, Germany.
Klautke
G
G
Virchow
J C
JC
Kundt
G
G
Fietkau
R
R
D000328:Adult; D000367:Age Factors; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077235:Vinorelbine
D014747:Vinblastine; D016190:Carboplatin; D002945:Cisplatin; D000077235:Vinorelbine