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.
BACKGROUND
: Treatment of elderly patients with stage III NSCLC is controversial. Limited data exist, as the elderly are underrepresented in clinical trials.


METHODS
: After ethics approval, we performed a retrospective review of 1372 stage III NSCLC patients treated at our institution during the period 1997-2007. Patients with malignant effusions and microscopic N2 discovered only postoperatively were excluded, leaving 740 who were classified by treatment plan: palliative (palliative chemotherapy or radiation [≤40 Gy]); nonsurgical multimodality (>40 Gy radiation ± chemotherapy); or surgical multimodality (chemotherapy, radiation, and surgery). Demographics, treatment, toxicity, and survival were analyzed by age, 0 to 65 years, n = 384; 66 to 75 years, n = 256; 76+ years, n = 100, and compared using log-rank, univariate, and multivariate statistical tests.


RESULTS
: Patients older than 65 years were more likely to have poor performance status (p < 0.0001), multiple comorbidities (p < 0.0001), and to receive palliative therapy only (p < 0.0001). Older and younger patients treated with curative intent with nonsurgical bimodality therapy or trimodality therapy including surgery had similar rates of grade 3/4 toxicity (0-65 years, 39%; 66-75 years, 43%; 76+ years, 5%; p = 0.18) and toxic death (0-65 years, 4%; 66-75 years, 4%; 76+ years, 0%; p = 0.76). Survival was worse with increasing age (p < 0.0001), likely due to greater use of palliative treatment in the elderly. When survival was analyzed for patients treated with curative intent, there was no difference between age groups for nonsurgical (p = 0.32) or surgical (p = 0.53) therapy.


CONCLUSIONS
: In select fit elderly patients, combined modality therapy is tolerable and is associated with survival similar to that of younger patients.
Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Hospital, Toronto, Ontario, Canada.
Linda E
LE
Coate
Christine
C
Massey
Andrew
A
Hope
Adrian
A
Sacher
Katherine
K
Barrett
Andrew
A
Pierre
Natasha
N
Leighl
Anthony
A
Brade
Marc
M
de Perrot
Tom
T
Waddell
Geoffrey
G
Liu
Ronald
R
Feld
Ronald
R
Burkes
B C John
BC
Cho
Gail
G
Darling
Alexander
A
Sun
Shaf
S
Keshavjee
Andrea
A
Bezjak
Frances A
FA
Shepherd
D000230:Adenocarcinoma / Q000628:therapy; D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018287:Carcinoma, Large Cell / Q000628:therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000628:therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000628:therapy*; D008297:Male; D009367:Neoplasm Staging; D010166:Palliative Care; D011013:Pneumonectomy; D011879:Radiotherapy Dosage; D012107:Research Design; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D000970:Antineoplastic Agents