title: How Do Elderly Poor Prognosis Patients Tolerate Palliative Concurrent Chemoradiotherapy for Locally Advanced Non-Small-Cell Lung Cancer Stage III? A Subset Analysis From a Clinical Phase III Trial.
abstract: BACKGROUND
  In a phase III trial of patients with unresectable, locally advanced, stage III non-small-cell lung cancer (NSCLC) with a poor prognosis, palliative concurrent chemoradiotherapy (CRT) provided a significantly better outcome than chemotherapy alone, except among performance status (PS) 2 patients. In the present subgroup analysis, we evaluated the effect on patients aged ≥ 70 years (42% of all included) compared with patients aged < 70 years enrolled in the trial.
  
  
  METHODS
  All patients received 4 courses of intravenous carboplatin and oral vinorelbine. The experimental arm also received radiotherapy (42 Gy in 15 fractions). The included patients were required to have large tumors (> 8 cm), weight loss (> 10% within the previous 6 months) and/or PS 2.
  
  
  RESULTS
  The overall survival was increased among the CRT patients in both age groups, but the difference was significant only in patients aged < 70 years (median survival, 14.8 vs. 9.7 months; P = .001; age ≥ 70 years, median survival, 10.2 vs. 9.1 months; P = .09). Patients aged ≥ 70 years experienced better preserved health-related quality of life (QOL) and significantly less hematologic toxicity. The 2- and 3-year survival was significantly increased in both age groups receiving CRT.
  
  
  CONCLUSIONS
  Elderly patients aged ≥ 70 years with unresectable, stage III, locally advanced, NSLCL and a poor prognosis can tolerate CRT with the doses adjusted to age and palliative intent. These results indicate that CRT can provide both survival and QOL benefits in elderly patients, except for those with PS 2 or worse. The male predominance in the ≥ 70-year-age group and the reduced chemotherapy intensity for the patients aged > 75 years might explain the lack of significant survival improvement among those patients aged ≥ 70 years.
authors.affiliation: Department of Medicine, Helgeland Hospital, Sandnessjøen, Norway; Department of Clinical Medicine, University of Tromsø, Tromsø, Norway. Electronic address: hans.henrik.strom@gmail.com.
authors.forename: Hans H
authors.initials: HH
authors.lastname: Strøm
authors.affiliation: Department of Clinical Medicine, University of Tromsø, Tromsø, Norway; Department of Oncology, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Roy M
authors.initials: RM
authors.lastname: Bremnes
authors.affiliation: The Cancer Clinic, St. Olavs Hospital, Trondheim, Norway.
authors.forename: Stein H
authors.initials: SH
authors.lastname: Sundstrøm
authors.affiliation: Department of Oncology, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Nina
authors.initials: N
authors.lastname: Helbekkmo
authors.affiliation: Department of Clinical Medicine, University of Tromsø, Tromsø, Norway; Department of Pulmonary Medicine, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Ulf
authors.initials: U
authors.lastname: Aasebø
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D011379:Prognosis; D011788:Quality of Life; D016019:Survival Analysis; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077235:Vinorelbine
chemical_list: D014747:Vinblastine; D016190:Carboplatin; D000077235:Vinorelbine
keywords: Age-related; Exploratory subgroup analysis; Inoperable; Negative prognostic factors; Unresectable