Treatment outcomes and safety of concurrent chemoradiation in older adults with unresectable stage III non-small-cell lung cancer.

BACKGROUND

Concurrent chemoradiotherapy (CCRT) is the standard treatment for patients with unresectable stage III non-small-cell lung cancer (NSCLC) and good performance status. However, there is no consensus regarding the treatment of older patients with stage III NSCLC. Therefore, this study aimed to investigate treatment outcomes and safety of CCRT in older patients with unresectable stage III NSCLC compared with those in younger patients.

METHODS

We retrospectively examined all patients with unresectable stage III NSCLC treated with CCRT between 2012 and 2023 at four Korean hospitals. Progression-free survival (PFS), overall survival (OS), and adverse events (AEs) were compared between patients aged ≥70 years (older) and those aged <70 years (younger). We also analyzed data for age cutoffs of 60, 65, and 75 years.

RESULTS

Among 131 participants, 47 were classified as older patients and 84 as younger patients. Baseline characteristics, including Eastern Cooperative Oncology Group performance status and comorbidities, were mostly similar. In multivariable-adjusted models, older and younger patients had similar PFS [adjusted hazard ratio (aHR), 1.45; 95% confidence interval (CI): 0.85-2.48]; the median PFS in older and younger patients was 9.9 and 12.9 months, respectively (P=0.94). However, in multivariable-adjusted models, older patients had worse OS (aHR, 2.33; 95% CI: 1.27-4.27); the median OS in older and younger patients was 24.1 and 27.2 months, respectively (P=0.36). AEs of any grade and those of grade ≥3 were not significantly different between older and younger groups.

CONCLUSIONS

Among patients with unresectable stage III NSCLC undergoing CCRT, older patients aged ≥70 years had similar PFS and AE rates compared with those aged <70 years. However, OS was worse in older patients. Considering age as a crucial factor in CCRT outcomes, efforts should be made to provide a more meticulous and careful approach for older patients.