A retrospective evaluation of therapeutic efficacy and safety of chemoradiotherapy in older patients (aged ≥ 75 years) with limited-disease small cell lung cancer: Insights from two institutions

Chemoradiotherapy in older patients with limited-disease small cell lung cancer

Authors

  • Ayako Shiono Department of Respiratory Medicine, International Medical Center, Saitama Medical University
  • Hisao Imai Gunma University Graduate School of Medicine
  • Satoshi Endo Division of Respiratory Medicine, Gunma Prefectural Cancer Center
  • Kazunori Katayama Department of Respiratory Medicine, International Medical Center, Saitama Medical University
  • Hideaki Sato Department of Respiratory Medicine, International Medical Center, Saitama Medical University
  • Kosuke Hashimoto Department of Respiratory Medicine, International Medical Center, Saitama Medical University
  • Yu Miura Department of Respiratory Medicine, International Medical Center, Saitama Medical University
  • Shohei Okazaki Division of Radiation Oncology, Gunma Prefectural Cancer Center
  • Takanori Abe Department of Radiation Oncology, International Medical Center, Saitama Medical University
  • Atsuto Mouri Department of Respiratory Medicine, International Medical Center, Saitama Medical University
  • Kyoichi Kaira Department of Respiratory Medicine, International Medical Center, Saitama Medical University
  • Ken Masubuchi Division of Respiratory Medicine, Gunma Prefectural Cancer Center
  • Kunihiko Kobayashi Department of Respiratory Medicine, International Medical Center, Saitama Medical University
  • Koichi Minato Division of Respiratory Medicine, Gunma Prefectural Cancer Center
  • Shingo Kato Department of Radiation Oncology, International Medical Center, Saitama Medical University
  • Hiroshi Kagamu Department of Respiratory Medicine, International Medical Center, Saitama Medical University

Abstract

Purpose: The standard treatment for patients in good general condition with limited-disease small cell lung cancer (LD-SCLC) is concurrent platinum/etoposide chemotherapy and thoracic radiotherapy (TRT). However, the efficacy and safety of chemoradiotherapy (CRT) in older patients with LD-SCLC has not been fully explored; moreover, the optimal treatment for this patient group remains unclear. This study aimed to investigate the feasibility and efficacy of CRT in older patients with LD-SCLC.

Methods: From April 2007 to June 2021, consecutive older patients (aged ≥75 years) with stage I to III LD-SCLC who received concurrent or sequential CRT at two institutions were retrospectively evaluated for efficacy and toxicity of CRT.

Results: A total of 32 older patients underwent concurrent CRT (n=19) or sequential CRT (n=13) for LD-SCLC. The median ages of the concurrent and sequential CRT groups were 77 years (range: 75–81) and 79 years (range: 76–92), respectively. The median number of chemotherapeutic treatment cycles was four (range, 1–5), and the response rate was 96.9% in all patients (94.7% in concurrent and 100% in sequential CRT groups). The median progression-free survival (PFS) and median overall survival (OS) for all patients were 11.9 and 21.1 months, respectively. The median PFS was 13.0 and 9.0 months in the concurrent CRT and sequential CRT groups, respectively, with no statistically significant difference (p=0.67). The median OS from the initiation of CRT was 19.2 and 23.5 months in the concurrent and sequential CRT groups, respectively (p=0.46). The frequencies of Grade ≥3 hematological adverse events were as follows: decreased white blood cell count, 20/32 (62.5%); decreased neutrophil count, 23/32 (71.9%); anemia, 6/32 (18.8%); decreased platelet count, 7/32 (21.9%); and febrile neutropenia, 3/32 (9.4%). Treatment-related deaths occurred in one patient from each group.

Conclusion: Although hematological toxicities, particularly reduced neutrophil count, were severe, CRT showed favorable efficacy in both concurrent and sequential CRT groups. However, concurrent CRT may not be feasible for all older patients with LD-SCLC; accordingly, sequential CRT may be considered as a treatment of choice for these patients. Further prospective trials are warranted to identify optimal treatment strategies for this patient group.

Author Biography

Hisao Imai, Gunma University Graduate School of Medicine

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Published

2024-09-09

How to Cite

Shiono, A., Imai, H., Endo, S., Katayama, K., Sato, H., Hashimoto, K., … Kagamu, H. (2024). A retrospective evaluation of therapeutic efficacy and safety of chemoradiotherapy in older patients (aged ≥ 75 years) with limited-disease small cell lung cancer: Insights from two institutions: Chemoradiotherapy in older patients with limited-disease small cell lung cancer. Radiology and Oncology, 58(3), 432–443. Retrieved from https://radioloncol.com/index.php/ro/article/view/4269

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Section

Clinical oncology