Originally published as JCO Early Release 10.1200/JCO.2003.12.019 on July 21 2003
Journal of Clinical Oncology, Vol 21, Issue 17
(September), 2003: 3201-3206
© 2003 American Society for Clinical Oncology
The Outcome of Combined-Modality Therapy for Stage III Non–Small-Cell Lung Cancer in the Elderly
Steven E. Schild,
Philip J. Stella,
Susan M. Geyer,
James A. Bonner,
William L. McGinnis,
James A. Mailliard,
Jeffery Brindle,
Aminah Jatoi,
James R. Jett
From the Mayo Clinic and Mayo Foundation, Rochester, MN; Michigan Cancer Consortium Community Clinical Oncology Program (CCOP), Ann Arbor, MI; University of Alabama at Birmingham, Birmingham, AL; Iowa Oncology Research Association CCOP, Des Moines, IA; Missouri Valley Cancer Consortium CCOP, Omaha, NE; Altru Health Systems, Grand Forks, ND.
Address reprint requests to Steven E. Schild, MD, Mayo Clinic, Desk R, 13400 E Shea Blvd, Scottsdale, AZ 85259; e-mail: sschild{at}mayo.edu.
Purpose: The North Central Cancer Treatment Group performed a phase III trial to determine whether chemotherapy plus either bid radiation therapy (RT) or daily (qd) RT resulted in a better outcome for patients with stage III non–small-cell lung cancer (NSCLC). No difference in survival was identified between the two arms. This secondary analysis was performed to examine the relationship between patient age and outcome.
Patients and Methods: Two hundred forty-six patients were randomized to receive etoposide plus cisplatin and either RT qd or split-course RT bid. This retrospective study compared the outcomes of patients aged  70 years ("elderly patients") with those of younger individuals. Of the 244 assessable patients, 63 (26%) were elderly, and 181 (74%) were younger individuals.
Results: The 2-year and 5-year survival rates were 39% and 18%, respectively, in patients younger than 70 years, compared with 36% and 13%, respectively, in elderly patients (P = .4). Grade 4+ toxicity occurred in 62% of patients younger than 70 years compared with 81% of elderly patients (P = .007). Grade 4+ hematologic toxicity occurred in 56% of patients younger than 70 years, compared with 78% of elderly patients (P = .003). Grade 4+ pneumonitis occurred in 1% of those younger than 70 years, compared with 6% of elderly patients (P = .02).
Conclusion: Toxicity, especially myelosuppression and pneumonitis, was more pronounced in the elderly patients receiving combined-modality therapy for locally advanced NSCLC. Despite increased toxicity, elderly patients have survival rates equivalent to younger individuals. Therefore, fit, elderly patients with locally advanced NSCLC should be encouraged to receive combined-modality therapy, preferably on clinical trials with cautious, judicious monitoring. Future studies should explore ways to decrease toxicity of therapy in elderly patients.
This study was conducted as a collaborative trial of the North Central Cancer Treatment Group and the Mayo Clinic, and was supported in part by the Public Health Service grant nos. CA-25224, CA-37404, CA-15083, CA-63826, CA-35269, CA-63849, CA-35113, CA-63848, CA-35416, CA-52352, CA-37417, CA-35103, CA-35448, CA-60276, CA-35195, CA-35101, and CA-35103.
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