Inoperable Lung Cancer Associated with Longer Survival Under Combined Modalities

Combined or sequential chemotherapy plus radiation therapy (RT) was associated with longer survival in elderly patients with stage III inoperable lung cancer or locally advanced non-small cell lung cancer (NSCLC), according to the results of a retrospective study published in Pulmonology.¹

Although the standard of care for patients with locally advanced, inoperable NSCLC is concurrent chemotherapy plus RT, few studies have evaluated this treatment in a population of elderly patients (≥70 years). The aim of this study was to evaluate the outcomes of different treatment approaches in this population of inoperable lung cancer.

The study authors reviewed medical records from 2259 patients with NSCLC treated at a single center in Istanbul, Turkey between 2005 and 2017. There were 130 patients who met the study criteria (age ≥70 with stage IIIA to stage IIIB locally advanced, inoperable NSCLC). Patients were stratified by treatment with chemotherapy alone, concurrent chemotherapy plus RT, sequential chemotherapy plus RT, and RT only.

At baseline, the median age was 72 years and 12% of patients were female. Most patients (96.2%) had a history of smoking. Stage IIIA or IIIB disease was present in 46.2% and 53.8% of patients, respectively. Tumor histology was most commonly squamous cell carcinoma, followed by unknown histology and adenocarcinoma.

Combined modalities with inoperable lung cancer were associated with longer survival time compared with chemotherapy or RT alone. The median overall survival (OS) was longest in the group that received concurrent chemotherapy plus RT at 33 months, followed by 20 months with sequential chemotherapy plus RT, 15 months with RT alone, and 10 months with just chemotherapy (P =.04).

Progression-free survival (PFS) followed a similar trend as OS, but was not statistically significant. The median PFS was longest with concurrent chemotherapy plus RT at 15 months, followed by 10 months with sequential chemotherapy and RT, 9.0 months with RT alone, and 8.0 months with chemotherapy alone (P =.077).

Shorter survival was significantly associated with stage IIIB disease (HR, 2.899; 95% CI, 1.894-4.438; P <.001), Eastern Cooperative Oncology Group (ECOG) performance status of 2 (HR, 2.106; 95% CI, 1.346-3.296; P =.001) or 3-4 (HR, 5.139; 95% CI, 2.689-9.822; P <.001), according to a multivariate analysis. Prolonged survival was independently associated with concurrent chemotherapy plus RT (HR, 0.452; 95% CI, 0.239-0.857; P =.015) and sequential chemotherapy plus RT (HR, 0.509; 95% CI, 0.284-0.912; P =.023).

“The use of combined treatment modality was associated with better survival in elderly patients with locally advanced NSCLC,” the study authors said, adding, “we therefore suggest that concurrent chemotherapy plus RT, when feasible, should be strongly considered in locally advanced NSCLC patients 70 years and over.”

Reference

Sakin A, Sahin S, Atci MM, et al. The effect of different treatment modalities on survival in elderly patients with locally advanced non-small cell lung cancer. Pulmonology. 2021;27(1):26-34. doi:10.1016/j.pulmoe.2019.11.007