Tolerance and benefits of treatment for elderly patients with limited small-cell lung cancer.
OBJECTIVE
Over 20% of all newly diagnosed Dutch patients with small-cell lung cancer (SCLC) are aged ≥75 years. Uncertainties still exist about safety and efficacy of chemotherapy and chemoradiation in elderly patients. We evaluated the association between patient characteristics and (completion of) treatment and also evaluated toxicity, response and survival in elderly patients with SCLC.


METHODS
Population-based data from patients aged 75 years or older and diagnosed with limited SCLC in 1997-2004 in The Netherlands were used (N = 368). Additional data on co-morbidity, motive for deviating from guidelines, grades 3-5 toxicity, response and survival were gathered from medical records.


RESULTS
Although only relatively fit elderly were selected for chemotherapy, almost 70% developed toxicity, leading to early termination of chemotherapy in over half of all patients. Median survival time was 6.7 months, but differed strongly according to type and completion of treatment (13.5 months for chemoradiation, 7.1 months for chemotherapy, 2.9 months for best supportive care, 11.5 months for patients receiving at least 4 cycles of chemotherapy and 3.6 months for less than 4 cycles).


CONCLUSIONS
Although toxicity rate was high and many patients could not complete the full chemotherapy, those who received chemotherapy or chemoradiation had a significantly better survival. We hypothesize that a better selection by proper geriatric assessments is needed to achieve a more favourable balance between benefit and harm.
Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, P.O. Box 231, 5600 AE, Eindhoven, The Netherlands; Department of Clinical Epidemiology, VieCuri Medical Centre, P.O. Box 1926, 5900 BX, Venlo, The Netherlands. Electronic address: research@viecuri.nl.
Maryska L G
ML
Janssen-Heijnen
Department of Geriatric Medicine, Tweesteden Hospital, P.O. Box 90107, 5000 LA, Tilburg, The Netherlands.
Huub A A M
HA
Maas
Department of Radiation Oncology, Amsterdam Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
Caro C E
CC
Koning
Department of Pulmonary Diseases, VieCuri Medical Centre, P.O. Box 1926, 5900 BX, Venlo, The Netherlands.
Brigitte A H A
BA
van der Bruggen-Bogaarts
Department of Pulmonary Diseases, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
Harry J M
HJ
Groen
Department of Medical Oncology, Medical Spectrum Twente, P.O. Box 50.000, 7500 KA, Enschede, The Netherlands.
A N Machteld
AN
Wymenga
D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D012042:Registries; D055752:Small Cell Lung Carcinoma / Q000401:mortality / Q000628:therapy*
Elderly; Outcome; Population-based; Small-cell lung cancer; Survival; Treatment