Gridelli Cesare, Langer Corey, Maione Paolo, Rossi Antonio, Schild Steven E
Division of Medical Oncology, S.G. Moscati Hospital, Avellino, Italy.
J Clin Oncol. 2007 May 10;25(14):1898-907. doi: 10.1200/JCO.2006.10.3085.
Elderly patients often have comorbidities and other characteristics that make the selection of treatment daunting.
We have reviewed the available evidence in the literature to gauge the results of therapy for elderly lung cancer patients.
The beneficial results achieved with adjuvant chemotherapy in the general population with early non-small-cell lung cancer (NSCLC) cannot be automatically extrapolated to the elderly, who are at higher risk of toxicity. Retrospective analyses of combined chemoradiotherapy in locally advanced NSCLC patients suggest equivalent therapeutic benefit for younger and older patients, despite heightened toxicity. There have been no elderly-specific phase III trials for locally advanced NSCLC. For advanced NSCLC, on the basis of evidence-based data, single-agent chemotherapy remains the standard of care for nonselected elderly patients. However, retrospective analyses suggest that the efficacy of platinum-based combination chemotherapy is similar in fit older and younger patients, with increased but acceptable toxicity for elderly patients. In limited-disease small-cell lung cancer (SCLC), sequential chemoradiotherapy is clearly less toxic compared with a standard concurrent approach, but our assessment of treatment is hindered by the absence of prospective elderly-specific trials. Although prophylactic cranial irradiation has emerged as a standard strategy, it should be omitted in patients with cognitive impairment. In extensive SCLC, etoposide in combination with either cisplatin or carboplatin has emerged as standard treatment; hematopoietic support may be necessary.
With the exception of advanced NSCLC, prospective elderly-specific studies are lacking. Available data suggest that outcomes in the fit elderly mirror results observed in younger patients, although toxicity is generally worse.
老年患者常伴有多种合并症及其他特征，这使得治疗方案的选择颇具挑战性。
我们回顾了文献中的现有证据，以评估老年肺癌患者的治疗结果。
在早期非小细胞肺癌（NSCLC）的普通人群中，辅助化疗所取得的有益结果不能直接外推至老年患者，因为他们发生毒性反应的风险更高。对局部晚期NSCLC患者同步放化疗的回顾性分析表明，尽管毒性增加，但年轻和老年患者的治疗获益相当。目前尚无针对局部晚期NSCLC的老年特异性Ⅲ期试验。对于晚期NSCLC，基于循证医学数据，单药化疗仍是未选择的老年患者的标准治疗方案。然而，回顾性分析表明，铂类联合化疗在身体状况良好的老年和年轻患者中的疗效相似，老年患者的毒性虽有所增加但仍可接受。在局限期小细胞肺癌（SCLC）中，序贯放化疗与标准同步放化疗相比，毒性明显更低，但由于缺乏前瞻性的老年特异性试验，我们对治疗的评估受到阻碍。尽管预防性颅脑照射已成为一种标准策略，但对于有认知障碍的患者应避免使用。在广泛期SCLC中，依托泊苷联合顺铂或卡铂已成为标准治疗方案；可能需要造血支持。
除晚期NSCLC外，缺乏针对老年患者的前瞻性研究。现有数据表明，身体状况良好的老年患者的治疗结果与年轻患者相似，尽管毒性通常更严重。
