Outcomes of Major Lung Resection After Induction Therapy for Non-Small Cell Lung Cancer in Elderly Patients

Abstract

Background This study analyzes the impact of age on perioperative outcomes and long-term survival of patients undergoing surgery after induction chemotherapy for non-small cell lung cancer. Methods Short- and long-term outcomes of patients with non-small cell lung cancer who were at least 70 years and received induction chemotherapy followed by major lung resection (lobectomy or pneumonectomy) from 1996 to 2012 were assessed using multivariable logistic regression, Kaplan-Meier, and Cox proportional hazard analysis. The outcomes of these elderly patients were compared with those of patients younger than 70 years who underwent the same treatment from 1996 to 2012. Results Of the 317 patients who met the study criteria, 53 patients were at least 70 years. The median age was 74 years (range, 70 to 82 years) in the elderly group, and induction chemoradiation was used in 24 (45%) patients. Thirty-day mortality was similar between the younger (n = 12) and elderly (n = 3) patients (5% versus 6%; p = 0.52). There were no significant differences in the incidence of postoperative complications between younger and elderly patients (49% versus 57%; p = 0.30). Patients younger than 70 years had a median overall survival (30 months; 95% confidence interval [CI], 24 to 43) and a 5-year survival (39%; 95% CI, 33 to 45) that was not significantly different from patients at least 70 years (median overall survival, 30 months; 95% CI, 18 to 68; and 5-year overall survival, 36%; 95% CI, 21 to 51). However, there was a trend toward worse survival in the elderly group after multivariable adjustment (hazard ratio, 1.43; 95% CI, 0.97 to 2.12; p = 0.071). Conclusions Major lung resection after induction chemotherapy can be performed with acceptable short-and long-term results in appropriately selected patients at least 70 years, with outcomes that are comparable to those of younger patients.

Minimal invasive surgery in locally advanced N2 non-small cell lung cancer

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“…In the surgery field, minimally invasive surgery (MIS), specially video-assisted thoracoscopic (VATS), has emerged as a completely nonrib spreading technique with long-term outcomes and overall oncologic efficacy equivalent to the traditional open thoracotomy (1)(2)(3)(4). Growing experience with this technique, together with the improvement in video technology and instrumentation, has allowed the VATS to evolve from early-stage to locally advanced NSCLC (stage IIIA-N2) (5)(6)(7). VATS has demonstrated multiples advantages compared to open thoracotomy, such as reduced postoperative pain, shorter hospital stays, diminisher inflammatory responses, early onset of patients' usual activities, and better tolerance to postoperative chemotherapy (8).…”

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“…In 2003 lung cancer was the second leading cause of cancer death in octogenarians; nevertheless there is evidence that this patient population is at risk for inadequate management because of a reluctance to perform surgery due to concerns about age-related comorbidities and outcomes (2). Geriatric patients are usually underrepresented in clinical trials and therefore there is a lack of data on outcomes of multimodal strategies (3,4). Although the standard treatment of locally advanced non-small-cell lung cancer (NSCLC) is a…”

Short and mid-term outcomes of multimodal treatment for locally-advanced non-small cell lung cancer in elderly patients

“…The geriatric population is increasing worldwide and lung cancer is frequently diagnosed in elderly patients representing a leading cause of death. Age per se has been shown to be an important risk factor for morbidity and mortality after lung resection for non-small cell lung cancer (NSCLC) [1][2][3][4][5][6] and also the incidence of other diseases is more frequent in the older population then the association between these two conditions could preclude a complete oncological treatment.…”