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Treatment of the elderly when cure is the goal: the influence of age on treatment selection and efficacy for stage III non-small cell lung cancer

Authors
 Linda E. Coate ; Christine Massey ; Frances A. Shepherd ; Andrea Bezjak ; Shaf Keshavjee ; Alexander Sun ; Gail Darling ; B. C. John Cho ; Ronald Burkes ; Ronald Feld ; Geoffrey Liu ; Tom Waddell ; Marc de Perrot ; Anthony Brade ; Natasha Leighl ; Andrew Pierre ; Katherine Barrett ; Adrian Sacher ; Andrew Hope 
Citation
 Journal of Thoracic Oncology, Vol.6(3) : 537~544, 2011 
Journal Title
 Journal of Thoracic Oncology 
ISSN
 1556-0864 
Issue Date
2011
Abstract
BACKGROUND: : Treatment of elderly patients with stage III NSCLC is controversial. Limited data exist, as the elderly are underrepresented in clinical trials. METHODS: : After ethics approval, we performed a retrospective review of 1372 stage III NSCLC patients treated at our institution during the period 1997-2007. Patients with malignant effusions and microscopic N2 discovered only postoperatively were excluded, leaving 740 who were classified by treatment plan: palliative (palliative chemotherapy or radiation [≤40 Gy]); nonsurgical multimodality (>40 Gy radiation ± chemotherapy); or surgical multimodality (chemotherapy, radiation, and surgery). Demographics, treatment, toxicity, and survival were analyzed by age, 0 to 65 years, n = 384; 66 to 75 years, n = 256; 76+ years, n = 100, and compared using log-rank, univariate, and multivariate statistical tests. RESULTS: : Patients older than 65 years were more likely to have poor performance status (p < 0.0001), multiple comorbidities (p < 0.0001), and to receive palliative therapy only (p < 0.0001). Older and younger patients treated with curative intent with nonsurgical bimodality therapy or trimodality therapy including surgery had similar rates of grade 3/4 toxicity (0-65 years, 39%; 66-75 years, 43%; 76+ years, 5%; p = 0.18) and toxic death (0-65 years, 4%; 66-75 years, 4%; 76+ years, 0%; p = 0.76). Survival was worse with increasing age (p < 0.0001), likely due to greater use of palliative treatment in the elderly. When survival was analyzed for patients treated with curative intent, there was no difference between age groups for nonsurgical (p = 0.32) or surgical (p = 0.53) therapy. CONCLUSION: : In select fit elderly patients, combined modality therapy is tolerable and is associated with survival similar to that of younger patients.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/94534
DOI
10.1097/JTO.0b013e31820b8b9b
Appears in Collections:
1. 연구논문 > 1. College of Medicine > Dept. of Internal Medicine
Yonsei Authors
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 http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=01243894-201103000-00019&LSLINK=80&D=ovft
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