Chemoradiotherapy safe, effective for older patients with limited-stage small cell lung cancer
Older patients with limited-stage small cell lung cancer achieved similar survival outcomes after concurrent chemoradiotherapy as younger patients, according to study results published in Journal of Thoracic Oncology.
Researchers also observed no significant difference in toxicity between the two age groups.
“Our results are particularly relevant [because] robust evidence to guide treatment decisions [for elderly patients with limited-stage small cell cancer] is lacking,” Marianna Christodoulou, researcher in the department of radiotherapy at The Christie NHS Foundation Trust, and colleagues wrote.
Christodoulou and colleagues analyzed the outcomes of 490 patients with limited-stage small cell lung cancer included in the randomized phase 3 CONVERT trial.
Researchers compared treatment outcomes between patients aged 70 years and older (n = 67; median age, 73 years; range 70-82) and patients aged younger than 70 years (n = 423; median age, 60 years; range 29-70).
Investigators randomly assigned patients to receive radiotherapy at 45 Gy in 30 twice-daily fractions over 3 weeks (age 70 years, n = 20; age < 70 years, n = 229) or 66 Gy in 33 once-daily fractions over 6.5 weeks (age 70 years, n = 38; age < 70 years, n = 203).
Platinum-based chemotherapy was administered concurrently.
Median follow-up was 46 months.
Median survival was 29 months (95% CI, 21-39) among older patients and 30 months (95% CI, 26-35) among younger patients. Median time to disease progression was 18 months (95% CI, 13-31) among older patients vs. 16 months (95% CI, 14-19) among younger patients.
Fewer older patients received the optimal number of radiotherapy fractions (73% vs. 85%; P = 0.03); however, chemotherapy compliance was similar in both groups.
Rates of grade 3 and grade 4 neutropenia were higher among older patients than younger patients (84% vs. 70%; P = 0.02), but researchers reported no significant difference in rates of neutropenic sepsis (4% vs. 7%) or death (3% vs. 1.4%).
Limitations of the study included the fact that only 14% were aged older than 70 years, and that all but two patients in the older group had ECOG performance status of 0 or 1.
“Concurrent chemoradiotherapy with modern radiotherapy techniques is safe and effective for fit, older patients with limited-stage small cell lung cancer,” Christodoulou and colleagues wrote. “Certainly, up to the age of 80 [years], chronological age as a sole factor should not be a barrier to this treatment being offered. Future work should concentrate on establishing elderly-specific clinical trials incorporating functional assessment tools.” – by John DeRosier
Disclosures: Christodoulou reports research funding from Cancer Research UK’s Clinical Trials Awards and Advisory Committee, French Ministry of Health, Canadian Cancer Society Research Institute, and European Organization for the Research and Treatment of Cancer. Please see the study for all other authors’ relevant financial disclosures.