With modern treatment, there appears to be a significant benefit to the use of combined modality therapy in elderly patients with LS-SCLC, even in those with medical comorbidities. For patients who would be expected to tolerate the acute effects of concurrent chemo-RT, there appears to be a significant long-term survival benefit over sequential therapy.
Christopher D. Corso, MD, PhD, Charles E. Rutter, MD, Henry S. Park, MD, MPH, Nataniel Lester-Coll, MD, Roy H. Decker, MD, PhD; Department of Therapeutic Radiology, Yale University School of Medicine
INTRODUCTION: Small-cell lung cancer (SCLC) in elderly patients is a frequent problem, with prior studies suggesting that 40% to 55% of patients with limited stage SCLC (LS-SCLC) are aged 70 years or older. A meta-analysis examining the role of thoracic radiotherapy (RT) in LS-SCLC suggested that there is no clear benefit to combined modality therapy over chemotherapy alone in patients aged over 70 years. In this retrospective study, we sought to investigate outcomes for elderly patients treated with chemotherapy alone vs chemotherapy (chemo)-RT in the modern era using a national database.
METHODS: We identified elderly patients (age ≥ 70 yr) diagnosed with LS-SCLC (cT1-T4, cN0-N3, cM0) in the National Cancer Data Base from 1998–2006. Patients treated with surgery or RT initiated > 30 days before or > 270 days after chemotherapy were excluded. Patients were stratified as receiving chemotherapy alone vus chemo-RT. The group receiving chemo-RT was further subdivided into concurrent vs sequential treatment. Concurrent therapy was defined as those starting RT 30 days before to 90 days after chemotherapy began. Overall survival (OS) from the start of treatment was compared between groups using log-rank analysis. Conditional survival analysis was performed for patients who were alive 6 months after the initiation of treatment.
RESULTS: We identified 20,836 patients who met the inclusion criteria; 47.9% received chemo alone, and 52.1% received chemo-RT. The median RT dose was 55.8 Gy. OS was significantly higher in the chemo-RT group when compared with patients who received chemo alone (median OS 20.0 mo vs 10.7 mo; log-rank P < .001). This survival benefit was observed in elderly patients with no comorbid illness and in those with multiple comorbidities. Analysis of the treatment sequence revealed a significant difference between concurrent vs sequential therapy by log-rank analysis (P < .037). The Kaplan-Meier curves crossed at approximately 18 months, suggesting that there is initially improved OS with sequential therapy, but long-term survival is improved with chemo-RT. Conditional survival analysis showed that patients who were alive 6 months after diagnosis had a significant survival benefit with concurrent chemo-RT over sequential therapy (2-yr OS 35% vs 27%; log-rank P < .001).
CONCLUSION: With modern treatment, there appears to be a significant benefit to the use of combined modality therapy in elderly patients with LS-SCLC, even in those with medical comorbidities. For patients who would be expected to tolerate the acute effects of concurrent chemo-RT, there appears to be a significant long-term survival benefit over sequential therapy.
Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org