Radiotherapy for non-small cell lung cancer in patients aged 75 and over: safety, effectiveness and possible impact on survival

For patients with advanced, inoperable non-small cell lung cancer (NSCLC), increasing age seems to be the primary reason of receiving no treatment. Th e elderly aged 75 years and over are more likely to be given only supportiv e care (irrespective of symptoms) or no therapy at all. We evaluated the ou tcome of 48 patients, aged 75 years and over, treated with radiation therap y for advanced (stage IIIA-B), inoperable, symptomatic NSCLC. A median dose of 50 Gy was delivered to the primary site and mediastinum with standard f ractionation. Based on WHO criteria, of 47 assessable patients, 21 had part ial remission, 17 stable disease, and nine had progressive disease. Most sy mptoms were successfully palliated. Toxicity was negligible and mainly cons isted of WHO grade I-II esophagitis. Despite the overall median survival be ing short (5 months), dose-related survival was much batter in patients giv en at least 50 Gy than in those treated with lower doses: 52% versus 35% at 6 months, and 28% versus 4% at 13 months. These results confirm that radia tion therapy may be safely delivered to very aged patients with advanced NS CLC at not merely palliative doses, both to achieve better local control an d to give likely survival benefits. Adequate pretreatment evaluation should be always performed to exclude any comorbidity unfit to chess radiation an d to individualize treatment to the single patient requirements. Because a large amount of literature data now concurs with the feasibility and safety of high-dose radiotherapy in the elderly, specifically designed, age-orien ted trials are needed to settle definitively the issue of survival advantag e from curative radiotherapy in these patients. (C) 2000 Elsevier Science I reland Ltd. All rights reserved.