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Abstract

Purpose 

Concurrent chemoradiotherapy is standard treatment for patients with stage III non-small-cell lung cancer. Elderly patients may experience increased rates of adverse events (AEs) or less benefit from concurrent chemoradiotherapy. 

Patients and Methods ​

Individual patient data were collected from 16 phase II or III trials conducted by US National Cancer Institute-supported cooperative groups of concurrent chemoradiotherapy alone or with consolidation or induction chemotherapy for stage III non-small-cell lung cancer from 1990 to 2012. Overall survival (OS), progression-free survival, and AEs were compared between patients age ≥ 70 (elderly) and those younger than 70 years (younger). Unadjusted and adjusted hazard ratios (HRs) for survival time and CIs were estimated by single-predictor and multivariable frailty Cox models. Unadjusted and adjusted odds ratio (ORs) for AEs and CIs were obtained from single-predictor and multivariable generalized linear mixed-effect models. 

Results 

A total of 2,768 patients were classified as younger and 832 as elderly. In unadjusted and multivariable models, elderly patients had worse OS (HR, 1.20; 95% CI, 1.09 to 1.31 and HR, 1.17; 95% CI, 1.07 to 1.29, respectively). In unadjusted and multivariable models, elderly and younger patients had similar progression-free survival (HR, 1.01; 95% CI, 0.93 to 1.10 and HR, 1.00; 95% CI, 0.91 to 1.09, respectively). Elderly patients had a higher rate of grade ≥ 3 AEs in unadjusted and multivariable models (OR, 1.35; 95% CI, 1.07 to 1.70 and OR, 1.38; 95% CI, 1.10 to 1.74, respectively). Grade 5 AEs were significantly higher in elderly compared with younger patients (9% v 4%; P < .01). Fewer elderly compared with younger patients completed treatment (47% v 57%; P < .01), and more discontinued treatment because of AEs (20% v 13%; P < .01), died during treatment (7.8% v 2.9%; P < .01), and refused further treatment (5.8% v 3.9%; P = .02). 

Conclusion 

Elderly patients in concurrent chemoradiotherapy trials experienced worse OS, more toxicity, and had a higher rate of death during treatment than younger patients.

Author information​

Stinchcombe TE1, Zhang Y1, Vokes EE1, Schiller JH1, Bradley JD1, Kelly K1, Curran WJ Jr1, Schild SE1, Movsas B1, Clamon G1, Govindan R1, Blumenschein GR1, Socinski MA1, Ready NE1, Akerley WL1, Cohen HJ1, Pang HH1, Wang X1.

1 Thomas E. Stinchcombe, Neal E. Ready, and Harvey J. Cohen, Duke University Medical Center; Xiaofei Wang, Alliance Statistics and Data Center, Durham, NC; Ying Zhang, Pennsylvania State University College of Medicine, Hershey, PA; Everett E. Vokes, University of Chicago Medical Center, Chicago, IL; Joan H. Schiller, Inova Dwight and Martha Schar Cancer Institute, Falls Church, VA; Jeffrey D. Bradley and Ramaswamy Govindan, Washington University School of Medicine, St Louis, MO; Karen Kelly, University of California Davis, Sacramento, CA; Walter J. Curran Jr, Winship Cancer Institute of Emory University, Atlanta, GA; Steven E. Schild, Mayo Clinic Arizona, Scottsdale, AZ; Benjamin Movsas, Henry Ford Health System, Detroit, MI; Gerald Clamon, University of Iowa Hospital and Clinics, Iowa City, IA; George R. Blumenschein, University of Texas MD Anderson Cancer Center, Houston, TX; Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL; Wallace L. Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; and Herbert H. Pang, University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.