Survival improved among elderly patients with non-small cell lung cancer (NSCLC) when they received combined chemotherapy and radiotherapy rather than radiotherapy alone, indicated the findings of a study conducted in Japan.
To assess whether radiotherapy plus carboplatin would result in longer survival than radiotherapy alone in elderly patients with advanced NSCLC, the Japan Clinical Oncology Group randomized 200 patients older than age 70 years with unresectable stage III disease to chemoradiotherapy or to radiotherapy alone. Specifically, the 100 members of the chemoradiotherapy group received a radiation dose of 60 Gy plus concurrent low-dose carboplatin (30 mg/m2 per day, 5 days per week, for 20 days).
At a median follow-up of 19.4 months, median overall survival for the chemoradiotherapy group was 22.4 months, compared with 16.9 months for the radiotherapy-only group. Although chemoradiotherapy was well tolerated, grade 3 and grade 4 hematologic toxic effects were more prevalent among those patients: Leucopenia occurred in 63.5% (61) of the chemoradiotherapy participants, but in none of the radiotherapy patients; neutropenia in 57.3% (55) of the chemoradiotherapy patients and none of the radiotherapy patients; and thrombocytopenia in 29.2% (28) of the chemoradiotherapy patients and just 2.0% (two) of the radiotherapy patients.
Grade 3 infection also was more common with chemoradiotherapy (occurring in 12.5%, or 12 patients) than with radiotherapy (4.1%, or four patients). Incidences of grade 3 and grade 4 pneumonitis and late lung toxicity were similar between groups. Seven treatment-related deaths occurred, in three chemoradiotherapy patients (3%) and four radiotherapy patients (4.0%).
Shinji Atagi, MD, of the Kinki-chuo Chest Medical Center in Osaka, Japan, and colleagues concluded in their report for The Lancet Oncology that combination chemoradiotherapy does in fact provide a clinically significant benefit over radiotherapy alone for a select group of elderly patients with locally advanced NSCLC, and that the combination treatment should be considered for this population.