Görkem AKSU, Merdan FAYDA, Mert SAYNAK, Esra Kaytan SAĞLAMER, Ethem Nezih ORAL, Ahmet KİZİR, Ahmet KARADENİZ

Radiotherapy as the primary and palliatıve treatment for 75 years and older patients with locally advanced and metastatic non-small cell lung cancer: Analysis of 45 cases wıth a review of the literature

Amaç: Lokal ileri veya metastatik KHDAK tanılı hastalarda prognostik faktörler ve tedavi sonuçlarının değerlendirilmesi Hastalar ve Metod: 75 yaş ve üzeri toplam 45 KHDAK tanılı hasta değerlendirildi. Medyan yaş 78 idi (75-93). Otuz dört hasta Evre IIIB (75%), 11 hasta (25%) ise Evre IV olarak evrelendirildi. Evre IIIB tanılı hastaların 14 tanesine (41%) küratif Radyoterapi (RT), 18 hastaya (52%) palyatif RT uygulanırken, 2 hasta (5%) sadece kemoterapi (KT) aldı. Bulgular: Bir yıllık genel sağkalım oranı %37 olarak tespit edildi. Medyan sağkalım; Evre IIIB hastalarda 12.7 ay olarak bulunurken, Evre IV hastalarda 7.67 ay olarak gözlendi. Tek değişkenli analizde, ileri evre (p= 0.0006), performans durumu (p=0.056), RT uygulanmaması (p=0.0008) ve kilo kaybı (p=0.0053) sağkalımı olumsuz olarak etkileyen faktörler olarak tespit edildi. Çoklu değişkenli analizde ise; sadece Evre IV hastalık, anlamlı kötü prognostik faktör olarak bulundu (p=0.0025 HR=0.2760 (0.12-0.60) 95% güvenlik aralığı). Sonuç: ≥ 75 yaş KHDAK tanılı Türk hastalarda, evre IV hastalığın kötü prognozla ilişkili olduğu saptandı. Evre IIIB hastalıkta ise, küratif RT dozlarının sağkalımı iyileştiremediği ancak, tek başına RT ile elde edilen sağkalımın, bu yaş hasta grubunda literatürde kemoradyoterapi ile elde edilen sonuçlara benzer olduğu tespit edildi.

75 yaş ve üzeri lokal ileri ve metastatatik küçük hücreli dışı akciğer kanserinde primer ve palyatif tedavi olarak radyoterapi uygulaması: 45 vakanın değerlendirilmesi ve literatür incelemesi

Aim: To evaluate the prognostic factors and treatment results of 75 years or older Turkish patients with locally advanced and metastatic non-small cell lung cancer (NSCLC). Patients and Methods: Forty-five patients ≥ 75 years were evaluated. Median age was 78 (75-93). Thirty-four patients (75%) had stage IIIB and 11 patients had stage IV disease (25%). Fourteen patients (41%) with stage IIIB disease were treated with curative radiotherapy (RT), 18 patients (52%) with palliative RT and 2 patients (5%) were treated with only chemotherapy (CT). Results: One-year survival rate was 37%. Overall median survival was 12.7 months in stage IIIB and 7.67 months in stage IV. In univariate analysis, advanced stage (p=0.0006), performance status (p=0.056), absence of radiotherapy (p=0.0008) and weight loss (p=0.0053) adversely affected the survival. In multivariate analysis only stage IV was found to be statistically significant independent poor prognostic factor (p=0.0025 HR=0.2760 (0.12-0.60) 95% confidence interval). Conclusion: In 75 years and older Turkish patients with NSCLC, stage IV disease was associated with poor prognosis. The higher radiotherapy doses did not improve survival in patients with stage IIIB disease and the prognosis with only radiotherapy is similar to the results of chemoradiation in the literature in this age group.

PDF

___

1) Lonardi, F., Coeli, M., Pavanato, G., Adami, F., Gioga, G., Campostrini, F. (2000) Radiotherapy for non-small cell lung cancer in patients aged 75 and over, safety, effectiveness and possible impact on survival. Lung Cancer, 28, 43-50.
2) Tombolini, V., Bonanni, A., Donato, V., Raffetto, N., Santarelli, M., Valeriani, M., Enrici, RM. (2000) Radiotherapy alone in elderly patients with medically inoperable stage IIIA and IIIB non-small cell lung cancer. Anticancer Res, 20, 4829-4833.
3) Rengan, R., Rosenzweig, KE., Venkatraman, E., Koutcher, LA., Fox, JL., Nayak, R., Amols, H., Yorke, E., Jackson, A., Ling, CC., Leibel, SA. (2004) Improved local control with higher doses of radiation in large-volume stage III non-small-cell lung cancer. Int J Radiat Oncol Biol Phys, 60, 741-7.
4) Finkelstein, DM., Ettinger, DS., Ruckdeschel, JC. (1986) Long-term survivors in metastatic non-small cell lung cancer: an Eastern Cooperative Oncology Group Study. J Clin Oncol, 4, 702–9.
5) Albain, KS., Crowley, JJ., LeBlanc, M., Livingston, RB. (1991) Survival determinants in extensive-stage non-small cell lung cancer: the Southwest Oncology Group experience. J Clin Oncol, 9, 1618–26.
6) Borges, M., Sculier, JP., Paesmans, M., Richez, M., Bureau, G., Dabouis, G., Lecomte, J., Michel, J., Van Cutsem, O., Schmerber, J., Giner, V., Berchier, MC., Sergysels, R., Mommen, P., Klastersky, J. (1996) Prognostic factors for response to chemotherapy containing platinum derivatives in patients with unresectable non-small cell lung cancer (NSCLC). Lung Cancer, 16, 21–33.
7) Stanley, KE. (1980) Prognostic factors for survival in patients with inoperable lung cancer. J Natl Cancer Inst, 65, 25–32.
8) Hillner, BE., McDonald, MK., Desch, CE., Smith, TJ., Penberthy, L., Retchin, SM. (1998). A comparison of patterns of care of nonsmall cell lung carcinoma patients in a younger and Medigap commercially insured cohort. Cancer, 83, 1930–7.
9) Smith, TJ., Penberthy, L., Desch, CE., Whittemore, M., Newschaffer, C., Hillner, BE., McClish, D., Retchin, SM. (1995). Differences in initial treatment patterns and outcomes of lung cancer in the elderly. Lung Cancer, 13, 235–52.
10) Jeremic B, Shibamoto Y. Pre-treatment prognostic factors in patients with stage III non-small cell lung cancer treated with hyperfractionated radiation therapy with or without concurrent chemotherapy. Lung Cancer 1995; 13: 21–30.
11) Langer C, Hsu C, Curran D et al. Do elderly patients with locally advanced non-small cell lung cancer benefit from combined modality therapy? A secondary analysis of RTOG 94-10. Int J Radiat Oncol Biol Phys 2001; 51: 20–21.
12) Gauden SJ, Tripcony L. The curative treatment by radiation therapy alone of Stage I non- small cell lung cancer in a geriatric population. Lung Cancer 2001; 32: 71–79.
13) Sause W, Kolesar P, Taylor SI, et al. Final results of phase III trial in regionally advanced unresectable non-small cell lung cancer: Radiation Therapy Oncology Group, Eastern Cooperative Oncology Group, and Southwest Oncology Group. Chest 2000; 117: 358–364.
14) Newman AB, Yanez D, Harris T, et al. Weight change in old age and its association with mortality. J Am Geriatr Soc 2001; 49: 1309–1318.
15) Movsas B, Scott C, Sause W, et al. The benefit of treatment intensification is age and histology-dependent in patients with locally advanced non-small cell lung cancer (NSCLC): a quality-adjusted survival analysis of radiation therapy oncology group (RTOG) chemoradiation studies. Int J Radiat Oncol Biol Phys 1999; 45: 1143–1149.
16) Numico G, Russi E, Merlano M. Best supportive care in non-small cell lung cancer: Is there a role for radiotherapy and chemotherapy? Lung Cancer 2001; 32: 213–226.
17) Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomized clinical trials. Non-small Cell Lung Cancer Collaborative Group. BMJ 1995; 311: 899–909.
18) Earle CC, Tsai JS, Gelber RD, et al. Effectiveness of chemotherapy for advanced lung cancer in the elderly: instrumental variable and propensity analysis. J Clin Oncol 2001; 19: 1064–70.
19) Effects of vinorelbine on quality of life and survival of elderly patients with advanced non-small cell lung cancer. The Elderly Lung Cancer Vinorelbine Italian Study Group. J Natl Cancer Inst 1999; 91: 66–72.
20) Gridelli C, Perrone F, Gallo C, et al. Chemotherapy for elderly patients with advanced non-small cell lung cancer: the Multicenter Italian Lung Cancer in the Elderly Study (MILES) phase III randomized trial. J Natl Cancer Inst 2003, 95: 362–72.
21) Frasci G, Lorusso V, Panza N, et al. Gemcitabine plus vinorelbine versus vinorelbine alone in elderly patients with advanced non-small cell lung cancer. J Clin Oncol 2000; 18: 2529–36.
22) Langer CJ, Manola J, Bernardo P, et al. Cisplatin-based therapy for elderly patients with advanced non-small cell lung cancer: implications of Eastern Cooperative Oncology Group 5592, a randomized trial. J Natl Cancer Inst 2002; 94: 173–81.
23) Kelly K, Giarritta S, Akerley W, et al. Should older patients (Pts) receive combination chemotherapy for advanced stage non-small cell lung cancer (NSCLC)? An analysis of Southwest Oncology Trials 9509 and 9308. Proc Am Soc Clin Oncol 2001; 20: 329a.
24) Hensing TA, Socinski MA, Schell MJ, et al. Age does not alter toxicity or survival for patients (pts) with stage IIIB/IV non-small cell lung cancer (NSCLC) treated with carboplatin (C) and paclitaxel (P). Proc Am Soc Clin Oncol 2001; 20: 346a.
25) Lilenbaum RC, Herndon J, List M, et al. Single-agent (SA) versus combination chemotherapy (CC) in advanced non-small cell lung cancer (NSCLC): a CALGB randomized trial of efficacy, quality of life (QOL), and cost-effectiveness. Proc Am Soc Clin Oncol 2002; 21: 1a.
26) Kris MG, Natale RB, Herbst RS, et al. A phase II trial of ZD1839 (‘Iressa’) in advanced non-small cell lung cancer (NSCLC) patients who had failed platinum- and docetaxel-based regimens (IDEAL 2). Proc Am Soc Clin Oncol 2002; 21: 292a.
27) Fukuoka M, Yano S, Giaccone G, et al. Multi-institutional randomized phase II trial of gefitinib for previously treated patients with advanced non-small cell lung cancer. J Clin Oncol 2003; 21: 2237–46.