Thoracic Oncology Unit, Department of Medical Oncology, Institut Català d'Oncologia, Hospital Duran i Reynals, Avinguda Gran via 199-203. L'Hospitalet, Barcelona 08908, Spain.
Geriatric Oncology Unit, Department of Medical Oncology, Institut Català d'Oncologia, Avinguda Gran via 199-203. L'Hospitalet, Barcelona 08908, Spain.
Br J Cancer. 2018 Mar 6;118(5):639-647. doi: 10.1038/bjc.2017.455. Epub 2018 Jan 30.
Although concurrent chemoradiotherapy (cCRT) increases survival in patients with inoperable, locally advanced non-small-cell lung cancer (NSCLC), there is no consensus on the treatment of elderly patients. The aim of this study was to determine the prognostic value of the comprehensive geriatric assessment (CGA) and its ability to predict toxicity in this setting.
We enrolled 85 consecutive elderly (⩾75 years) participants, who underwent CGA and the Vulnerable Elders Survey (VES-13). Those classified as fit and medium-fit by CGA were deemed candidates for cCRT (platinum-based chemotherapy concurrent with thoracic radiation therapy), while unfit patients received best supportive care.
Fit (37%) and medium-fit (48%) patients had significantly longer median overall survival (mOS) (23.9 and 16.9 months, respectively) than unfit patients (15%) (9.3 months, log-rank P=0.01). In multivariate analysis, CGA groups and VES-13 were independent prognostic factors. Fit and medium-fit patients receiving cCRT (n=54) had mOS of 21.1 months (95% confidence interval: 16.2, 26.0). In those patients, higher VES-13 (⩾3) was associated with shorter mOS (16.33 vs 24.3 months, P=0.027) and higher risk of G3-4 toxicity (65 vs 32%, P=0.028).
Comprehensive geriatric assessment and VES-13 showed independent prognostic value. Comprehensive geriatric assessment may help to identify elderly patients fit enough to be treated with cCRT.
虽然同步放化疗（cCRT）可提高不能手术的局部晚期非小细胞肺癌（NSCLC）患者的生存率，但对于老年患者的治疗尚无共识。本研究旨在确定综合老年评估（CGA）的预后价值及其在这种情况下预测毒性的能力。
我们纳入了 85 例连续的老年（⩾75 岁）患者，他们接受了 CGA 和脆弱性老年人调查（VES-13）。通过 CGA 被评为健康和中等健康的患者被认为是 cCRT（基于铂的化疗联合胸部放射治疗）的候选者，而不健康的患者则接受最佳支持性护理。
健康（37%）和中等健康（48%）的患者的中位总生存期（mOS）明显长于不健康的患者（15%）（分别为 23.9 和 16.9 个月，log-rank P=0.01）。多变量分析显示，CGA 组和 VES-13 是独立的预后因素。接受 cCRT 的健康和中等健康的患者（n=54）的 mOS 为 21.1 个月（95%置信区间：16.2，26.0）。在这些患者中，更高的 VES-13（⩾3）与较短的 mOS（16.33 与 24.3 个月，P=0.027）和更高的 G3-4 毒性风险（65%与 32%，P=0.028）相关。
综合老年评估和 VES-13 显示出独立的预后价值。综合老年评估可能有助于识别足够健康的老年患者，可以接受 cCRT 治疗。
