In a nutshell
The objective of this review was to provide advice on treatment options for different stages of non-small cell lung cancer (NSCLC) in elderly patients.
Some background
NSCLC tends to occur more in older age. The average age of onset of NSCLC is 70 years. Treatment of elderly patients can be complicated with other health concerns, so several issues are faced in deciding the correct treatment options. Some of these issues are: deciding the best treatment for localized NSCLC (cancer that has not spread to distant organs), deciding if additional therapy is needed with the primary treatment and choosing the appropriate chemotherapy if cancer spreads to other parts of the body (metastasis).
Methods & findings
The authors reviewed a number of trials evaluating NSCLC in elderly patients.
In localized NSCLC, lobectomy (removal of one or more subsections of the lung) was found to be appropriate for many. For some, partial removal of a lobe or small piece of the lung was effective. The choice depended on the patient's ability to withstand the duration of surgery. In local NSCLC that was not suitable for surgery, radiation therapy was found to be an effective option. In several studies, radiotherapy was associated with an overall survival of 2 years in the majority of 66-74 year old patients.
In locally advanced NSCLC (cancer has moved into the lymph nodes) that was not suitable for surgery, the effect of chemoradiotherapy (combination of chemotherapy and radiotherapy) was analyzed in elderly patients (> 70 years). Overall survival was 22.4 months in patients undergoing chemoradiotherapy compared to 16.9 months with radiotherapy alone.
For metastatic NSCLC in patients over 65 years, chemotherapy is most effective. An analysis was conducted to evaluate the benefit of chemotherapy with two drugs over one drug. Overall survival, 1 year survival rate and period between treatment and disease progression improved significantly with two-drug chemotherapy treatment compared to single-drug therapy. The two-drug chemotherapy regimen was platinum-based, i.e. dependent on chemotherapy drugs such as carboplatin (Paraplatin) or oxaliplatin (Eloxatin).
The bottom line
The authors concluded that radiotherapy may be an alternate option to surgery in localized NSCLC. For locally advanced non-operable NSCLC, chemoradiotherapy could be beneficial. For elderly, fit patients with metastatic NSCLC, chemotherapy is the treatment of choice.
Published By :
Annals of oncology
Date :
Jul 24, 2014
