NEW YORK (Reuters Health) - Elderly patients with limited-stage small-cell lung cancer (LS-SCLC) may live longer after chemoradiotherapy (CRT) than after chemotherapy (CT) alone, a new study reports.
Doctors should treat elderly patients who have LS-SCLC according to each individual's overall health picture - not only their age - and should consider using CRT instead of CT when patients are expected to tolerate the toxicities, researchers say.
"When we controlled for other risk factors, the use of thoracic radiotherapy was the strongest predictor of improved overall survival (OS)," Dr. Roy H. Decker from Yale University School of Medicine in New Haven, Connecticut, told Reuters Health by email. "This effect persisted even in the highest-risk subsets of patients - those over 80 - or those with significant medical comorbidities."
"We were not surprised by the overall finding, although the magnitude of the difference - median survival of 15.6 versus 9.3 months favoring CRT - was striking," he added. "Also notable was the fact that the benefit persisted even in the highest-risk patients: those with a Charlson comorbidity score of 2, or those over 80 years old."
Using data from the National Cancer Data Base spanning 2003 to 2011, Dr. Decker and his colleagues analyzed outcomes of patients 70 years and older who had LS-SCLC clinical stage I to III and received CT or CRT.
Of the more than 8,600 patients they identified, 44% received CT and 56% received CRT. The odds of receiving CRT decreased significantly with increasing age, female sex, clinical stage III disease and the presence of comorbidities.
On both univariate and multivariate analysis, CRT was associated with significantly longer overall survival (OS, median, 15.6 vs. 9.3 months; three-year OS, 22.0% vs. 6.3%; p<0 .001="" p="">
Propensity score matching confirmed the survival benefit associated with CRT (hazard ratio, 0.52; p<0 .001="" p="">0>
"We also analyzed the sequence of therapy, comparing concurrent chemoradiotherapy to sequential, and the results were complex. Overall, we found a small but significant improvement in survival for concurrent therapy, but at the earliest time points, the survival with this strategy was worse (the curves crossed). This implies higher treatment-related mortality for the more aggressive concurrent therapy, but that, at later time points, the benefit of concurrent outweighed the increase in toxicity," Dr. Decker said.
Dr. Alice Wang-Chesebro, medical director of the Clackamas Radiation Oncology Center of Providence Health & Services in Clackamas, Oregon, said, "These findings support our clinical experience, where evolving technology has allowed us to support patients, including the elderly, through more effective treatments. Radiation techniques in particular have changed significantly over the last decade, reducing both short-term and long-term toxicity."
"Chronologic age in of itself is not a limiting factor for treatment," Dr. Wang-Chesebro, who was not involved in the study, told Reuters Health by email. "Each individual needs to be given the opportunity to explore their options."
Dr. Regan M. Duffy, medical oncologist at Providence Health & Services in Portland, Oregon, noted in an email to Reuters Health, "Elderly patients have typically been excluded from clinical trials evaluating these treatments, and it has remained unclear whether healthy elderly patients experience harm from these therapies. Elderly patients with SCLC represent a very large subset of all patients with SCLC, so this analysis will impact the care of many patients."
Regarding study limitations, Dr. Duffy, who was also not involved in the research, "The authors attempted to control for the selection bias inherent in retrospective analysis using advanced statistical methods; however, the reasons for selection of CT versus CRT for individual patients remain unknown."
J Clin Oncol 2015.0>