How Do Elderly Poor Prognosis Patients Tolerate Palliative Concurrent Chemoradiotherapy for Locally Advanced NoneSmall Cell Lung Cancer Stage III? A Subset Analysis From a Clinical Phase III Trial

Abstract

In a phase III trial of patients with unresectable stage III nonesmall-cell lung cancer and a poor prognosis, palliative concurrent chemoradiotherapy (CRT) provided a significantly better outcome than chemotherapy alone, except among performance status 2 patients. The results of the present exploratory subgroup analysis indicate that elderly patients with poor prognosis can also experience health-related quality of life and survival benefits from CRT, provided the treatment modalities have been adapted to a palliative setting. Background: In a phase III trial of patients with unresectable, locally advanced, stage III nonesmall-cell lung cancer (NSCLC) with a poor prognosis, palliative concurrent chemoradiotherapy (CRT) provided a significantly better outcome than chemotherapy alone, except among performance status (PS) 2 patients. In the present subgroup analysis, we evaluated the effect on patients aged 70 years (42% of all included) compared with patients aged < 70 years enrolled in the trial. Patients and Methods: All patients received 4 courses of intravenous carboplatin and oral vinorelbine. The experimental arm also received radiotherapy (42 Gy in 15 fractions). The included patients were required to have large tumors (> 8 cm), weight loss (> 10% within the previous 6 months) and/or PS 2. Results: The overall survival was increased among the CRT patients in both age groups, but the difference was significant only in patients aged < 70 years (median survival, 14.8 vs. 9.7 months; P ¼ .001; age 70 years, median survival, 10.2 vs. 9.1 months; P ¼ .09). Patients aged 70 years experienced better preserved health-related quality of life (QOL) and significantly less hematologic toxicity. The 2- and 3-year survival was significantly increased in both age groups receiving CRT. Conclusion: Elderly patients aged 70 years with unresectable, stage III, locally advanced, NSLCL and a poor prognosis can tolerate CRT with the doses adjusted to age and palliative intent. These results indicate that CRT can provide both survival and QOL benefits in elderly patients, except for those with PS 2 or worse. The male predominance in the 70-year-age group and the reduced chemotherapy intensity for the patients aged > 75 years might explain the lack of significant survival improvement among those patients aged 70 years.