title: Survival data in elderly patients with locally advanced non-small cell lung cancer.
abstract: Combined chemoradiation (CRT) is the standard therapy in locally advanced non-small cell lung cancer (NSCLC). Nevertheless, the best approach in the elderly population is still poorly defined. We retrospectively reviewed the charts of elderly (≥ 65 years) patients with unresectable, locally advanced NSCLC, diagnosed at the Brazilian National Cancer Institute between 2003 and 2007. The primary outcome was overall survival (OS), measured from diagnosis until death. Palliative therapy (PT) included best supportive care radiation therapy (RT; ≤ 40 Gy) and palliative chemotherapy. Among patients treated with radical RT, OS was measured from date of treatment beginning until death (OST). One hundred seventy-one patients were included, with median age of 71 years (range 65-90). Thirty-nine percent received PT, 32 % exclusive RT (>40 Gy), and 29 % CRT (concomitant or sequential). Patients treated with RT and CRT had better OS (median 13.7 months [95 % CI 10.9-16.4] and 15.5 months [95 % CI 13.0-17.9]) than PT (median 4.1 months [95 % CI 3.6-4.6]; p < 0.0001). In the multivariate analysis, RT (HR 0.28 [95 % CI 0.18-0.42]; p < 0.0001) and CRT (HR 0.17 [95 % CI 0.1-0.27]; p < 0.0001) were independently correlated to better survival in comparison with PT. Among patients receiving radical RT, the addition of chemotherapy was correlated to longer OST (median 13.8 [95 % CI 10.6-17.0] vs. 10.8 months [95 % CI 8.6-13.1]; p = 0.018). This benefit was confirmed in the multivariate analysis (HR 0.59 [95 % CI 0.36-0.97]; p = 0.039). Elderly patients with locally advanced NSCLC derived significant survival benefit from radical RT and CRT, suggesting that age should not be a contraindication for these aggressive therapeutic strategies.
authors.affiliation: Medical Oncology Department and Thoracic Oncology Tumor Group, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil. pedromasson@ig.com.br
authors.forename: Pedro Masson
authors.initials: PM
authors.lastname: Domingues
authors.forename: Ricardo
authors.initials: R
authors.lastname: Zylberberg
authors.forename: Thalita
authors.initials: T
authors.lastname: da Matta de Castro
authors.forename: Clarissa Seródio
authors.initials: CS
authors.lastname: Baldotto
authors.forename: Luiz Henrique
authors.initials: LH
authors.lastname: de Lima Araujo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000628:therapy*; D059248:Chemoradiotherapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality* / Q000628:therapy*; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies