Chemoradiotherapy effective for elderly patients with limited-stage small cell lung cancer

Chemoradiotherapy may extend survival compared with chemotherapy alone among elderly patients with limited-stage small cell lung cancer, according to results of a population-based retrospective analysis.

“Elderly patients who are candidates to receive [chemotherapy] should be strongly considered for [chemoradiotherapy], which appears to confer a large additional OS advantage beyond that achieved with [chemotherapy] alone,” Roy H. Decker, MD, PhD, of the department of therapeutic radiology at Yale University School of Medicine, and colleagues wrote.

Roy H. Decker

Decker and colleagues reviewed the National Cancer Data Base to identify 8,637 patients aged at least 70 years diagnosed between 2003 and 2011 with limited-stage small cell lung cancer, defined as stage I to stage III disease.

Patients underwent either chemotherapy (n = 3,775; 43.7%) or chemoradiotherapy (n = 4,862; 56.3%).

Use of chemoradiotherapy declined with age and the presence of stage III disease (P < .01 for both).

Univariable analysis revealed several factors associated with OS. They included receipt of chemoradiotherapy, age younger than 80 years, female sex, Charlson-Devo score 0, clinical stage I disease and treatment with nonsingle-agent chemotherapy. These associations persisted on multivariable analysis.

Multivariable analyses showed patients who underwent chemoradiotherapy achieved significantly longer median OS (15.6 months vs. 9.32 months; P < .001). Researchers also reported a significantly higher 3-year OS rate in the chemoradiotherapy arm (22% vs. 6.3%; P < .001).

Using propensity score matching, the researchers identified a matched cohort of 6,856 patients, in which a CRT–associated survival benefit was confirmed (HR = 0.52; 95% CI, 0.5-0.55).

In a subset analysis of treatment order, the researchers determined that — among patients alive 4 months after diagnosis — concurrent chemoradiotherapy conferred a survival benefit over sequential chemoradiotherapy (median OS, 17 months vs. 15.4 months; P = .01).

“Treatment decisions in elderly patients with [limited-stage small cell lung cancer] should be based on patient-specific criteria, and elderly age alone should not be a contraindication for multimodality treatment,” Decker and colleagues wrote. – by Jennifer Byrne

Reference:

Corso CD, et al. J Clin Oncol. 2015;doI:10.1200/JCO.2015.62.4270

Disclosure: Decker reports stock or other ownership in Bristol-Myers Squibb, consultant or advisory roles with Leidos Biomedical Research, and research funding from Merck. Please see the full study for all other researchers’ relevant financial disclosures.