Radiat Oncol J.  2019 Sep;37(3):176-184. 10.3857/roj.2019.00087.

Chemoradiotherapy versus radiotherapy alone following induction chemotherapy for elderly patients with stage III lung cancer

• Kim DY
• Song C
• Kim SH
• Kim YJ
• Lee JS
• Kim JS

• KMID: 2460742
• DOI: http://doi.org/10.3857/roj.2019.00087

Abstract

PURPOSE
It is unclear whether adding concurrent chemotherapy (CT) to definitive radiotherapy (RT) following induction CT is a tolerable and cost effective treatment for non-small-cell lung cancer (NSCLC) patients aged 70 years or older with comorbidities. This study evaluated the actual clinical outcomes between concurrent chemoradiotherapy (CCRT) and RT alone following induction CT or not in patients (≥70 years) in a single institution's clinical practice.
MATERIALS AND METHODS
A total of 82 patients with unresectable stage III NSCLC between 2004 and 2016 were retrospectively analyzed. Their treatment tolerance and clinical outcomes such as overall survival (OS), locoregional recurrence (LRR), treatment toxicities and distant metastasis (DM) were evaluated. Early mortality rates were also evaluated as 4-month mortality after RT.
RESULTS
Fifty-four patients received CCRT and 28 patients received RT alone. Induction CT before RT was performed for 68.5% and 50.0% in CCRT and RT alone groups. Treatment tolerance was significantly worse in CCRT (p = 0.046). The median survival was 21.1 and 18.1 months for CCRT and RT alone, which was not statistically significant. LRR and DM were also not different. Most early deaths after CCRT were attributed to non-cancer-related mortality. Acute esophagitis of grade ≥2 occurred more following CCRT (p = 0.017). In multivariate analysis, a Charlson Comorbidity Index (CCI) of ≥5 and a weight loss of ≥5% after RT were associated with poor OS. The factors adversely affecting 4-month survival were a CCI of ≥5 and CCRT.
CONCLUSION
There were no significant differences in OS, LRR, and DM between CCRT and RT alone treatment in elderly patients. However, there was a poorer tolerance and higher incidence of acute esophagitis in the CCRT group. Specifically, when the patients had a CCI of ≥5, RT alone seems to be reasonable with a low probability of early death.

Keyword

Non-small cell lung cancer; Concurrent chemoradiotherapy; Induction chemotherapy; Radiotherapy; Aged 70 and over; Comorbidity

MeSH Terms

Aged*
Carcinoma, Non-Small-Cell Lung
Chemoradiotherapy*
Comorbidity
Drug Therapy
Esophagitis
Humans
Incidence
Induction Chemotherapy*
Lung Neoplasms*
Lung*
Mortality
Multivariate Analysis
Neoplasm Metastasis
Radiotherapy*
Recurrence
Retrospective Studies
Weight Loss