title: Comorbidity and outcomes of concurrent chemo- and radiotherapy in limited disease small cell lung cancer.
abstract: BACKGROUND
  Many patients with limited disease small cell lung cancer (LD SCLC) suffer from comorbidity. Not all patients with comorbidity are offered standard treatment, though there is little evidence for such a policy. The aim of this study was to investigate whether patients with comorbidity had inferior outcomes in a LD SCLC cohort.
  
  
  METHODS
  We analyzed patients from a randomized study comparing two three-week schedules of thoracic radiotherapy (TRT) plus standard chemotherapy in LD SCLC. Patients were to receive four courses of cisplatin/etoposide and TRT of 45 Gy/30 fractions (twice daily) or 42 Gy/15 fractions (once daily). Responders received prophylactic cranial irradiation (PCI). Comorbidity was assessed using the Charlson Comorbidity Index (CCI), which rates conditions with increased one-year mortality.
  
  
  RESULTS
  In total 157 patients were enrolled between May 2005 and January 2011. Median age was 63 years, 52% were men, 16% had performance status 2, and 72% stage III disease. Forty percent had no comorbidity; 34% had CCI-score 1; 15% CCI 2; and 11% CCI 3-5. There were no significant differences in completion rates of chemotherapy, TRT or PCI across CCI-scores; or any significant differences in the frequency of grade 3-5 toxicity (p = 0.49), treatment-related deaths (p = 0.36), response rates (p = 0.20), progression-free survival (p = 0.18) or overall survival (p = 0.09) between the CCI categories.
  
  
  CONCLUSIONS
  Patients with comorbidity completed and tolerated chemo-radiotherapy as well as other patients. There were no significant differences in response rates, progression-free survival or overall survival - suggesting that comorbidity alone is not a reason to withhold standard therapy in LD SCLC.
authors.affiliation: a Department of Cancer Research and Molecular Medicine , NTNU, Norwegian University of Science and Technology , Trondheim , Norway.|b Clinic of Oncology, St. Olavs Hospital , Trondheim University Hospital , Trondheim , Norway.
authors.forename: Tarje Onsøien
authors.initials: TO
authors.lastname: Halvorsen
authors.affiliation: b Clinic of Oncology, St. Olavs Hospital , Trondheim University Hospital , Trondheim , Norway.
authors.forename: Stein
authors.initials: S
authors.lastname: Sundstrøm
authors.affiliation: c Department of Thoracic Medicine , Haukeland University Hospital , Bergen , Norway.
authors.forename: Øystein
authors.initials: Ø
authors.lastname: Fløtten
authors.affiliation: d Department of Oncology , Oslo University Hospital, The Norwegian Radium Hospital , Oslo , Norway.|e Institute of Clinical Medicine , University of Oslo , Oslo , Norway.
authors.forename: Odd T
authors.initials: OT
authors.lastname: Brustugun
authors.affiliation: d Department of Oncology , Oslo University Hospital, The Norwegian Radium Hospital , Oslo , Norway.
authors.forename: Paal
authors.initials: P
authors.lastname: Brunsvig
authors.affiliation: f Department of Pulmonology , University Hospital of North Norway , Tromsø , Norway.|g Department of Clinical Medicine, Faculty of Medicine , The Arctic University of Norway , Tromsø , Norway.
authors.forename: Ulf
authors.initials: U
authors.lastname: Aasebø
authors.affiliation: g Department of Clinical Medicine, Faculty of Medicine , The Arctic University of Norway , Tromsø , Norway.|h Department of Oncology , University Hospital of North Norway , Tromsø , Norway.
authors.forename: Roy M
authors.initials: RM
authors.lastname: Bremnes
authors.affiliation: a Department of Cancer Research and Molecular Medicine , NTNU, Norwegian University of Science and Technology , Trondheim , Norway.|c Department of Thoracic Medicine , Haukeland University Hospital , Bergen , Norway.|d Department of Oncology , Oslo University Hospital, The Norwegian Radium Hospital , Oslo , Norway.|e Institute of Clinical Medicine , University of Oslo , Oslo , Norway.
authors.forename: Stein
authors.initials: S
authors.lastname: Kaasa
authors.affiliation: a Department of Cancer Research and Molecular Medicine , NTNU, Norwegian University of Science and Technology , Trondheim , Norway.|b Clinic of Oncology, St. Olavs Hospital , Trondheim University Hospital , Trondheim , Norway.
authors.forename: Bjørn H
authors.initials: BH
authors.lastname: Grønberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use; D015897:Comorbidity; D016371:Cranial Irradiation; D018572:Disease-Free Survival; D005047:Etoposide / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D055752:Small Cell Lung Carcinoma / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality / Q000532:radiotherapy*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D005047:Etoposide; D002945:Cisplatin