Definitive radiotherapy alone over 60 Gy for patients unfit for combined treatment to stage II-III non-small cell lung cancer: retrospective analysis

Abstract

BackgroundElderly patients with non-small cell lung cancer (NSCLC) are frequently treated with radiation therapy (RT) alone, due to poor performance status or underlying disease. We investigated the effectiveness of RT over 60 Gy administered alone to NSCLC patients who were unfit or rejecting for combination treatment.Methods and materialsFrom April 2002 to July 2010, 83 patients with stage II-III NSCLC, aged over 60 years, treated by RT alone with a curative aim were analyzed. Radiation was targeted to the primary tumor and clinically involved lymph nodes. A total dose of 66 Gy in 30 fractions (2.2 Gy/fraction) was delivered once daily (5 fractions weekly). One month after completing RT, initial tumor responses were evaluated.ResultsMedian age of patients was 73 years (range, 60 – 82 years). The median survival time was 18.6 months (range, 2–135). The actuarial overall survival rates at 2 and 3 years were 39 % and 23 %, and cause-specific survival rate at 2 and 3 years were 57 % and 47 %, respectively. When primary tumor was controlled, the 2- and 3-year CSS were 56 % and 45 %, but 32 % and 23 % in those patients with local failure, respectively (P = 0.017). Additionally, the local control rate was associated with the initial tumor response (P = 0.01). No patient experienced grade 4+ toxicity.ConclusionsFor stage II-III NSCLC patients aged over 60 years and unfit or rejecting for combination treatment, RT alone showed promising result. Long-term disease control can be expected if an early tumor response to radiation is achieved, which could result in improved overall survival rates.

Stage III Non-Small Cell Lung Cancer in the elderly: Patient characteristics predictive for tolerance and survival of chemoradiation in daily clinical practice

“…The proportion of patients receiving cCHRT (33%) was comparable to other elderly-specific studies (33-41%) [14,22] and less often administered to patients aged P75 with PS P 2 and severe comorbidity. Both PS and comorbidity are important indications for treatment toxicity and survival as reflected by the most common motives for omitting cCHRT and should be analyzed carefully before treatment decision-making [5,7,9,21]. Not choosing intensive treatment could originate from cherishing a good QoL instead of longer survival time at the end of life [7,11].…”

“…Possibly, worse survival for cCHRT could also be explained by poor-risk patients receiving carboplatin more often and higher survival rates can be reached in selected patients receiving cisplatin [39]. Due to minor differences in survival and less adverse events, it can be suggested that sCHRT is more feasible than cCHRT in unselected elderly [4] and RT remains an alternative for CHRT in patients with severe comorbidity [9,10]. However, cCHRT should not be denied to selected elderly patients [14,19,40].…”

“…Nevertheless, cCHRT is considered standard treatment [2][3][4][5]. Alternative curative treatment options are sCHRT [6][7][8] and radical radiotherapy (RT) [9,10]. Symptom relief and preservation of quality of life (QoL) is offered to patients not eligible for curative options by palliative care or best supportive care [7,11].…”

Spontaneous regression of ALK fusion protein-positive non-small cell lung carcinoma: a case report and review of the literature

“…Unsurprisingly, SR has not been reported previously in the ALK rearranged subpopulation. Local recurrence-free survival rate at 2 years following radical radiotherapy alone is offered at approximately 29% with modern treatment in the unselected NSCLC population [54], but this value is thought to be lower in oncogenic NSCLC [5,7]. Local control was achieved for 24 months in the case outlined despite ALK rearrangement (see Fig.…”

Population-based analysis of curative therapies in stage II non-small cell lung cancer: the role of radiotherapy in medically inoperable patients

“…For inoperable stage II patients, the optimal treatment is much less certain. Chemoradiation or radical doses of radiotherapy alone remain a curative option, however there is limited evidence to guide this approach, and outcomes are unclear [17][18][19].…”