P2.02-020 Pattern of Care of Inoperable Locally Advanced (LA) NSCLC in Elderly Patients: Analysis of the Experience of Two Academic Italian Hospitals

Abstract

Optimal treatment in LA NSCLC patients is still debated. In fit patients concomitant radio-chemotherapy (RCT) seems to be the best treatment in terms of local control (LC), progression free survival (PFS) and overall survival (OS) while sequential RCT is a good alternative in unfit patients. Moderately hypofractionated radiotherapy improve OS in recent studies. Elderly patients often cannot be offered multimodality treatments. We report our experience with over 70 years old LA NSCLC patients deemed unfit for surgery. Tabled 1Patients' CharacteristicsAgeMedian75Range70-83GenderMale50 (70%)Female21 (30%)Performance Status (ECOG)0129 (41%)36 (51)26 (8%)HistologyAdenocarcinoma31 (44%)Squamous Cell Carcinoma39 (55%)Large Cell Carcinoma1 (1%)StageIIa/IIb12 (17%)IIIa39 (55%)IIIb20 (28%)ChemotherapyConcomitant9 (13%)Sequential62 (87%)Cycles: median4Cycles: range1-8RadiotherapyMedian Dose62,3 GyModerate hypofractionation26 (37%)Conventional fractionation45 (63%) Open table in a new tab Characteristics of patients and treatments are summarized in table 1. All patients were treated with a platinum based doublet of chemotherapy (CT). RT target volumes included the primary lung tumor and involved mediastinal lymphnodes as defined on pre-treatment contrast enhanced CT scan. Elective nodal irradiation was not performed. Acute/late toxicities were reported in accordance to 4.0 CTCAE scale. Clinical response was evaluated according to RECIST criteria. At a median follow up of 10 months clinical response was evaluable in 69/71 patients obtaining a partial response in 35 of them, stable disease in 17, progressive disease in 17 patients. Twenty six patients experienced a local relapse within RT primary tumor volume, while 13 on nodal volume (5 patients both tumor and nodal relapse). 22 patients developed metastatic disease. One and 3-year OS was 62.3% (SE±6.2%) and 24,5% (SE±7.8%) respectively, while 1- and 3 year PFS was 45.1% (SE±6.9%) and 9,7% (SE±5.7%) respectively. At univariate analysis, tumor dimension (p<0,002) was the only prognostic factor statistically significant for OS. G1-G2 acute toxicity was observed in 45 patients: 36/62 in sequential CRT (3/36 developed also chronic toxicities) and 9/9 in concomitant CRT; most events were G1 oesophagitis (27 patients) and G1 cough (17 patients). No G3-4 event was reported. CRT is feasible in elderly patients; multidisciplinary evaluation is needed in order to reserve CRT to very fit patients.