UNLABELLED

There is much debate whether the choice of management for elderly patients with locally advanced, inoperable NSCLC with good performance status (PS) should be made entirely on terms of age.

MATERIAL AND METHOD

We compared the results of chemotherapy (CT), radiotherapy (RT) and chemoradiotherapy (CT-RT) of the elderly with those of younger patients, and studied predictive factors for survival in these age groups. 231 patients with advanced NSCLC were included in this study, being grouped by age: > 65 years (148p, 64.1%) versus < 65 years old (83p, 35.9%). Univariate analysis and Cox regression models were used to assess significance of variables for prediction of survival.

RESULTS

Mean overall survival (OS) for the whole group was 11.48 months (median 9.0 months); no significant difference in median OS was found between elderly and younger patients (11.55 vs. 11.65 months, p = 0.537). Univariate analysis revealed significant survival benefits in both age groups as per weight loss < 5%, absence of comorbidities, earlier clinical stage, high initial Hb levels, longer time-to-progression (TTP) and good PS. Treatment type had different survival impact on the age groups; best median survival in patients > 65 years (14.0 months) was obtained by CT alone, while patients < 65 years benefited more (13.35 months) from sequential CT-RT. Logistic regression model identified 5 variables to be significant for survival in all patients: PS, extent of disease, hemoglobin (Hb), TTP and age. When applied to the elderly group, only 4 variables had predictive value: extent of disease, Hb, TTP and presence of comorbidities. Treatment toxicity did not differ significantly between age subsets, except for renal toxicity, which was greater in elderly patients. Age should not be a choice-limiting item for the treatment of advanced NSCLC.

CONCLUSION

An active therapeutic approach, such as chemotherapy, can be feasible, effective and well tolerated in selected elderly NSCLC patients with a good PS and no associated comorbidities.