Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Saitama, Japan.
Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Gunma, Japan.
Radiol Oncol. 2024 Sep 15;58(3):432-443. doi: 10.2478/raon-2024-0054. eCollection 2024 Sep 1.
The standard treatment for patients in good general condition with limited-disease small cell lung cancer (LD-SCLC) is concurrent platinum/etoposide chemotherapy and thoracic radiotherapy (TRT). However, the efficacy and safety of chemoradiotherapy (CRT) in older patients with LD-SCLC has not been fully explored; moreover, the optimal treatment for this patient group remains unclear. This study aimed to investigate the feasibility and efficacy of CRT in older patients with LD-SCLC.
From April 2007 to June 2021, consecutive older patients (aged ≥ 75 years) with stage I to III SCLC who received concurrent or sequential CRT at two institutions were retrospectively evaluated for efficacy and toxicity of CRT.
A total of 32 older patients underwent concurrent (n = 19) or sequential (n = 13) CRT for LD-SCLC. The median ages of the patients in the concurrent and sequential CRT groups were 77 (range: 75-81) years and 79 (range: 76-92) years, respectively. The median number of chemotherapeutic treatment cycles was four (range, 1-5), and the response rate was 96.9% in all patients (94.7% in concurrent and 100% in sequential CRT groups). The median progression-free survival (PFS) and median overall survival (OS) for all patients were 11.9 and 21.1 months, respectively. The median PFS was 13.0 and 9.0 months in the concurrent CRT and sequential CRT groups, respectively, with no statistically significant difference ( = 0.67). The median OS from the initiation of CRT was 19.2 and 23.5 months in the concurrent and sequential CRT groups, respectively ( = 0.46). The frequencies of Grade ≥ 3 hematological adverse events were as follows: decreased white blood cell count, 20/32 (62.5%); decreased neutrophil count, 23/32 (71.9%); anemia, 6/32 (18.8%); decreased platelet count, 7/32 (21.9%); and febrile neutropenia, 3/32 (9.4%). Treatment-related deaths occurred in one patient from each group.
Although hematological toxicities, particularly reduced neutrophil count, were severe, CRT showed favorable efficacy in both concurrent and sequential CRT groups. However, concurrent CRT may not be feasible for all older patients with LD-SCLC; accordingly, sequential CRT may be considered as a treatment of choice for these patients. Further prospective trials are warranted to identify optimal treatment strategies for this patient group.
对于一般状况良好的局限期小细胞肺癌（LD-SCLC）患者，标准治疗方法是同时进行铂类/依托泊苷化疗和胸部放疗（TRT）。然而，老年 LD-SCLC 患者的放化疗（CRT）疗效和安全性尚未得到充分探索；此外，该患者群体的最佳治疗方法仍不清楚。本研究旨在探讨 CRT 在老年 LD-SCLC 患者中的可行性和疗效。
2007 年 4 月至 2021 年 6 月，在两个机构接受同步或序贯 CRT 的连续 32 名年龄≥75 岁的 SCLC 患者，回顾性评估 CRT 的疗效和毒性。
32 名老年患者（年龄≥75 岁）行同步（n=19）或序贯（n=13）放化疗治疗 LD-SCLC。同步和序贯 CRT 组患者的中位年龄分别为 77（范围：75-81）岁和 79（范围：76-92）岁。中位化疗周期数为 4（范围：1-5），所有患者的缓解率为 96.9%（同步组为 94.7%，序贯组为 100%）。所有患者的中位无进展生存期（PFS）和中位总生存期（OS）分别为 11.9 和 21.1 个月。同步 CRT 组和序贯 CRT 组的中位 PFS 分别为 13.0 和 9.0 个月，无统计学差异（=0.67）。从 CRT 开始的中位 OS 分别为 19.2 和 23.5 个月，两组无统计学差异（=0.46）。≥3 级血液学不良事件的频率如下：白细胞减少 20/32（62.5%）；中性粒细胞减少 23/32（71.9%）；贫血 6/32（18.8%）；血小板减少 7/32（21.9%）；发热性中性粒细胞减少症 3/32（9.4%）。每组各有 1 例患者发生与治疗相关的死亡。
尽管血液学毒性，尤其是中性粒细胞减少症较为严重，但 CRT 同步和序贯 CRT 组均显示出良好的疗效。然而，并非所有老年 LD-SCLC 患者均适合同步 CRT；因此，序贯 CRT 可能是这些患者的首选治疗方法。需要进一步的前瞻性试验来确定该患者群体的最佳治疗策略。
