The Outcome of Combined-Modality Therapy for Stage III Non–Small-Cell Lung Cancer in the Elderly

2003 ◽  
Vol 21 (17) ◽  
pp. 3201-3206 ◽  
Author(s):  
Steven E. Schild ◽  
Philip J. Stella ◽  
Susan M. Geyer ◽  
James A. Bonner ◽  
William L. McGinnis ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Advanced Nsclc ◽  
Combined Modality Therapy ◽  
Locally Advanced ◽  
Survival Rates ◽  
The Elderly ◽  
Small Cell Lung ◽  
Combined Modality ◽  
Locally Advanced Nsclc ◽  
To Receive

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.

Lung Cancer in the Elderly

2007 ◽  
Vol 25 (14) ◽  
pp. 1898-1907 ◽  
Author(s):  
Cesare Gridelli ◽  
Corey Langer ◽  
Paolo Maione ◽  
Antonio Rossi ◽  
Steven E. Schild
Keyword(s):  
Lung Cancer ◽  
Elderly Patients ◽  
Small Cell Lung Cancer ◽  
Advanced Nsclc ◽  
Locally Advanced ◽  
The Elderly ◽  
Small Cell ◽  
Small Cell Lung ◽  
Younger Patients ◽  
Locally Advanced Nsclc

PurposeElderly patients often have comorbidities and other characteristics that make the selection of treatment daunting.MethodsWe have reviewed the available evidence in the literature to gauge the results of therapy for elderly lung cancer patients.ResultsThe beneficial results achieved with adjuvant chemotherapy in the general population with early non–small-cell lung cancer (NSCLC) cannot be automatically extrapolated to the elderly, who are at higher risk of toxicity. Retrospective analyses of combined chemoradiotherapy in locally advanced NSCLC patients suggest equivalent therapeutic benefit for younger and older patients, despite heightened toxicity. There have been no elderly-specific phase III trials for locally advanced NSCLC. For advanced NSCLC, on the basis of evidence-based data, single-agent chemotherapy remains the standard of care for nonselected elderly patients. However, retrospective analyses suggest that the efficacy of platinum-based combination chemotherapy is similar in fit older and younger patients, with increased but acceptable toxicity for elderly patients. In limited-disease small-cell lung cancer (SCLC), sequential chemoradiotherapy is clearly less toxic compared with a standard concurrent approach, but our assessment of treatment is hindered by the absence of prospective elderly-specific trials. Although prophylactic cranial irradiation has emerged as a standard strategy, it should be omitted in patients with cognitive impairment. In extensive SCLC, etoposide in combination with either cisplatin or carboplatin has emerged as standard treatment; hematopoietic support may be necessary.ConclusionWith the exception of advanced NSCLC, prospective elderly-specific studies are lacking. Available data suggest that outcomes in the fit elderly mirror results observed in younger patients, although toxicity is generally worse.

scholarly journals Efficacy and Safety Aiming at the Combined-Modality Therapy of External Beam Radiotherapy (40Gy) and Iodine-125 Seed Implantation for Locally Advanced NSCLC in the Elderly

2020 ◽  
Author(s):  
LiJun Tian ◽  
HongZhi Liu ◽  
Qiang Zhang ◽  
Dian-Zhong Geng ◽  
Yu-Qing Huo ◽  
...  
Keyword(s):  
Chest Wall ◽  
Advanced Nsclc ◽  
Combined Modality Therapy ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
The Elderly ◽  
Seed Implantation ◽  
Combined Modality ◽  
Locally Advanced Nsclc ◽  
Iodine 125

Abstract Background Our retrospective study aimed to evaluate the efficacy and safety of the combined-modality therapy for tumor invading the chest wall of locally advanced non-small-cell lung cancer (NSCLC) in the elderly. Methods We retrospectively enrolled 21 elderly patients (aged ≥ 60 years) with locally advanced NSCLC diagnosed as tumor invading the chest wall. The prescription dose of the primary tumor adopting external beam radiotherapy (EBRT) was given 40 Gy which was supplemented with iodine-125 seed implantation, meanwhile the lymph nodes of mediastinum undergoing EBRT was given 60 Gy. Follow-up was conducted every 3 months postoperatively. The related analytic parameters were the change of tumor size, the objective response rate (ORR), the disease control rate (DCR), the degree of pain relief, the improvement of physical status and the toxicity. Results The combined-modality therapy could significantly inhibit the local growth of tumor (from 7.84 ± 1.20 to 4.69 ± 1.90 cm) (P < 0.0001), indicating a better validity with an ORR of 71.4% and DCR 90.5%, respectively at 1 year. The cancer-related pain was significantly relieved (P < 0.05) and the physical status were also significantly improved (P < 0.05). There was no procedure-associated death or grade > 2 irradiation-related adverse effect in our study. Conclusions The combined-modality therapy of EBRT with 40 Gy and permanent iodine-125 seed implantation is an efficacious and safe option and may be recommended as a treatment pattern for the elderly of locally advanced NSCLC with tumor invading the chest wall.

scholarly journals Outcomes After Combined Modality Therapy for EGFR ‐Mutant and Wild‐Type Locally Advanced NSCLC

2011 ◽  
Vol 16 (6) ◽  
pp. 886-895 ◽  
Author(s):  
Raymond H. Mak ◽  
Elizabeth Doran ◽  
Alona Muzikansky ◽  
Josephine Kang ◽  
Joel W. Neal ◽  
...  
Keyword(s):  
Advanced Nsclc ◽  
Combined Modality Therapy ◽  
Locally Advanced ◽  
Wild Type ◽  
Combined Modality ◽  
Locally Advanced Nsclc ◽  
Egfr Mutant

Multiinstitutional phase II trial of paclitaxel, carboplatin, and concurrent radiation therapy for locally advanced non-small-cell lung cancer.

1998 ◽  
Vol 16 (10) ◽  
pp. 3316-3322 ◽  
Author(s):  
H Choy ◽  
W Akerley ◽  
H Safran ◽  
S Graziano ◽  
C Chung ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Phase Ii ◽  
Advanced Nsclc ◽  
Response Rate ◽  
Combined Modality Therapy ◽  
Locally Advanced ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Free Survival ◽  
Locally Advanced Nsclc

PURPOSE Combined modality therapy for non-small-cell lung cancer (NSCLC) has produced promising results. A multiinstitutional phase II clinical trial was conducted to evaluate the activity and toxicity of paclitaxel, carboplatin, and concurrent radiation therapy on patients with locally advanced NSCLC. PATIENTS AND METHODS Forty previously untreated patients with inoperable locally advanced NSCLC entered onto a phase II study from March 1995 to December 1996. On an outpatient basis for 7 weeks, patients received paclitaxel 50 mg/m2 weekly over 1 hour; carboplatin at (area under the curve) AUC 2 weekly; and radiation therapy of 66 Gy in 33 fractions. After chemoradiation therapy, patients received an additional two cycles of paclitaxel 200 mg/m2 over 3 hours and carboplatin at AUC 6 every 3 weeks. RESULTS Thirty-nine patients were eligible for the study. The survival rates at 12 months were 56.3%, and at 24 months, 38.3%, with a median overall survival of 20.5 months. The progression-free survival rates at 12 months were 43.6%, and at 24 months, 34.7%, with a median progression-free survival of 9.0 months. Two patients did not receive more than 2 weeks of concurrent chemoradiotherapy and were not assessable for toxicity and response. The overall response rate (partial plus complete response) of 37 assessable patients was 75.7%. The major toxicity was esophagitis. Seventeen patients (46%) developed grade 3 or 4 esophagitis. However, only two patients developed late esophageal toxicity with stricture at 3 and 6 months posttreatment. CONCLUSION Combined modality therapy with paclitaxel, carboplatin, and radiation is a promising treatment for locally advanced NSCLC that has a high response rate and acceptable toxicity and survival rates. A randomized trial will be necessary to fully evaluate the usefulness of these findings.

scholarly journals Phase I Study of Weekly Nab-Paclitaxel Plus Carboplatin And Concurrent Thoracic Radiotherapy in Elderly Patients with Unresectable Locally Advanced Non-Small-Cell Lung Cancer

2021 ◽  
Author(s):  
Shota Omori ◽  
Hideyuki Harada ◽  
Keita Mori ◽  
Yasushi Hisamatsu ◽  
Yuko Tsuboguchi ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Elderly Patients ◽  
Phase I Study ◽  
Advanced Nsclc ◽  
Locally Advanced ◽  
Small Cell ◽  
Recommended Dose ◽  
Thoracic Radiotherapy ◽  
Small Cell Lung ◽  
Locally Advanced Nsclc

Abstract Few clinical studies have been designed for elderly patients with locally advanced non-small cell lung cancer (NSCLC). We conducted a phase I study to evaluate the tolerability of carboplatin/nab-paclitaxel and concurrent thoracic radiotherapy in elderly patients with locally advanced NSCLC. The eligibility criteria were: unresectable stage III NSCLC, performance status 0 or 1, and age ≥75 years. Eligible patients received 6 weeks of weekly carboplatin/nab-paclitaxel and concurrent thoracic radiotherapy with a total dose of 64 Gy in 32 fractions. Carboplatin was fixed to an area under the plasma concentration time curve (AUC) of 2 mg/mL/min, and the recommended dose of nab-paclitaxel was evaluated using a dose-escalation study (30 or 40 mg/m2). Tolerability at the recommended dose was evaluated in an expansion study. Nineteen patients were enrolled at four institutions, all of whom were eligible and assessable. The recommended nab-paclitaxel dose was set at 30 mg/m2 because two patients experienced dose-limiting toxicity at 40 mg/m2. The treatment completion rate of the 17 patients analyzed at the recommended dose was 100% (80% confidence interval (CI), 83.8–100%). The overall response rate was 76.5%, and the median progression free survival was 13.4 months (95% CI, 4.2–21.4 months). Common grade 3 and 4 toxicities included leukopenia (23.5%), neutropenia (17.6%), anemia (5.9%), and infection (5.9%). One treatment-related death due to pneumonitis was observed six months after the end of the study. In conclusion, carboplatin/nab-paclitaxel and concurrent thoracic radiotherapy show good tolerability and exhibit promising efficacy in elderly patients with locally advanced NSCLC. This trial was registered with the Japan Registry of Clinical Trials on March 11, 2019 (trial no. jRCTs042180077).

scholarly journals Outcomes of Elderly Patients Who Receive Combined Modality Therapy for Locally Advanced Non–Small-Cell Lung Cancer

2017 ◽  
Vol 18 (1) ◽  
pp. e21-e26 ◽  
Author(s):  
Mark Zaki ◽  
Michael Dominello ◽  
Gregory Dyson ◽  
Shirish Gadgeel ◽  
Antoinette Wozniak ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Elderly Patients ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Combined Modality Therapy ◽  
Locally Advanced ◽  
Small Cell ◽  
Small Cell Lung ◽  
Combined Modality
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