Lower Incidence of Esophagitis in the Elderly Undergoing Definitive Radiation Therapy for Lung Cancer.
Most patients with lung cancer are elderly and poorly represented in randomized clinical trials. They are often undertreated because of concerns about their ability to tolerate aggressive treatment. We tested the hypothesis that elderly patients undergoing definitive lung radiation might tolerate treatment differently than younger patients.



A total of 125 patients who underwent definitive lung radiotherapy were identified from a prospective institutional database (University of Michigan cohort). Logistic regression modeling was performed to assess the impact of age on esophagitis grade 2 or higher or grade 2 or higher and pneumonitis grade 3 or higher or grade 2 or higher, with adjustment for esophageal and lung dose, respectively, as well as for chemotherapy utilization, smoking status, and performance status. The analysis was validated in a large cohort of 691 patients from the Michigan Radiation Oncology Quality Consortium registry, an independent statewide prospective database.



In the University of Michigan cohort, multivariable regression models revealed a significant inverse correlation between age and rate of esophagitis for both toxicity levels, (adjusted OR = 0.93 for both models and 95% confidence intervals of 0.88-0.98 and 0.87-0.99), with areas under the curve of 0.747 and 0.721, respectively, demonstrating good fit. This same association was noted in the Michigan Radiation Oncology Quality Consortium cohort. There was no significant association between age and pneumonitis.



There is a lower incidence of esophagitis with increasing age even after adjustment for use of chemotherapy. This is a novel finding in thoracic oncology. No age dependence was noted for pulmonary toxicity. The elderly are able to tolerate definitive thoracic radiation well and should be offered this option when clinically warranted.
Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
Payal D
PD
Soni
Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.
Philip S
PS
Boonstra
Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.
Matthew J
MJ
Schipper
Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
Latifa
L
Bazzi
Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
Robert T
RT
Dess
Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
Martha M
MM
Matuszak
Department on Radiation Oncology, Indiana University, Indianapolis, Indiana.
Feng-Ming
FM
Kong
Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
James A
JA
Hayman
Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
Randall K
RK
Ten Haken
Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
Theodore S
TS
Lawrence
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Gregory P
GP
Kalemkerian
Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan. Electronic address: shrutij@med.umich.edu.
Shruti
S
Jolly
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004941:Esophagitis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000532:radiotherapy*; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D011832:Radiation Injuries / Q000453:epidemiology* / Q000209:etiology; D017564:Radiation Pneumonitis / Q000453:epidemiology* / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects*; D015996:Survival Rate
Elderly; Esophagitis; Lung Cancer; Radiation; Toxicity