Outcomes of combined modality treatment in elderly patients with stage III non-small cell lung cancer.

Abstract

7049 Background: The use of combined modality treatment (CMT) has been demonstrated to improve survival in patients with inoperable, locally advanced NSCLC. Elderly patients have been traditionally excluded from prospective clinical trials investigating CMT and thus the optimal treatment strategy for these patients remains unclear. We retrospectively evaluated the outcomes of elderly patients who received concurrent and sequential chemoradiation. Methods: All lung cancer patients age 70 or older who received chemotherapy and radiation treatment at Mt. Sinai Medical Center for stage III NSCLC between 1997 and 2010 were analyzed from tumor registry data. Among 282 lung cancer elderly patients diagnosed with stage III disease, 64 patients (22.7 %) received CMT as part of their treatment. Patients who underwent surgery and palliative radiation were excluded. Statistical analysis was performed by log-rank, Kaplan-Meier methods, and t-test. Results: Median age at diagnosis for the CMT group was 75 years (70-87), male/female: 34/30, TNM: T4N0-1: 12, T3N1: 1, TXN2: 41, TXN3: 10. Concurrent chemoradiation was delivered in 43 cases and sequential in 21 cases. RT doses ranged from 50 to 63 Gy. The most common chemotherapy regimens used were carboplatin and taxol (44 %) and carboplatin and etoposide (15%). The most common treatment-related toxicities were esophagitis (42%), anemia (39%), and pneumonia (24%). Median survival (MST) was 19 months and 11 months in the concurrent and sequential chemoradiation groups (p=0.67). Observed two, three and five-year overall survival (OS) in the CMT group was 49.1%, 27.5%, and 12.5%, respectively. Conclusions: Although CMT is not commonly used in elderly patients with lung cancer, the treatment is feasible and beneficial for selected patients in the community setting. Interestingly, the MST of elderly patients who received CMT in this cohort was comparable to that of younger historical controls with CMT. There was also a trend for increased survival in the concurrent versus sequential chemoradiation group.