Long-term results of concurrent chemoradiotherapy in elderly patients with unresectable stage III non-small cell lung cancer

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Purpose Chemoradiotherapy and adjuvant immunotherapy have become the standard of care for patients with unresectable stage III non-small cell lung cancer (NSCLC). In elderly patients, chemoradiotherapy is often considered too burdensome and is therefore frequently omitted or discontinued. We retrospectively analysed the long-term results of concurrent daily low-dose cisplatin and radiotherapy (CCRT) in patients with unresectable stage III NSCLC, with a particular focus on age. Methods Between 2005 and 2015, 154 consecutive patients with unresectable NSCLC received CCRT consisting of daily low-dose cisplatin (6 mg/m 2 ) administered concurrently with 24 fractions of 2.75 Gy to a total dose of 66 Gy over 5 weeks. Disease recurrence, metastases and treatment complications were assessed by clinical examination and radiological imaging (CT, PET-CT, MRI). Observed survival, disease-free survival (DFS) and complication rates were estimated using the Kaplan-Meier (KM) method; Cox regression model was used to examine differences between non-elderly patients (age ≤70.0 years; n=106) and elderly patients (>70.0 years; n=48). Relative survival (RS) rates were calculated to adjust for age- and sex-specific background mortality . Results The median follow-up for survival was 34 months (range, 1-204 months), and for recurrence, metastasis and complication 29 months (range, 1-140 months). The observed KM survival rates at 1, 5 and 10 years were 79%, 39% and 19%, respectively. Median survival was 33 months. In non-elderly patients (≤ 70.0 years), the KM survival rates were 78%, 38% and 24% (median 35 months); in elderly patients (>70.0 years), the rates were 81%, 42% and 10% (median 31 months) (p= 0.1). The RS rates at 1, 5 and 10 years for non-elderly patients were 79%, 39% and 26% (median 35 months), for the elderly patients 84%, 48% and 13% (median 35 months; p = 0.5). Disease Free Survival at 1, 5, and 10 years were 67%, 43% and 40%. Worse ECOG scale, no surgery and a large treated volume of positive lymph nodes (GTV lymph nodes) were significant risk factors for poor survival. Local tumour volume and no surgery were an independent risk factors for distant metastasis. Age and surgery were significant risks for recurrence. A large treated volume of the positive lymph nodes treated was a significant risk factor for treatment complications. Conclusion CCRT with daily low-dose cisplatin and high-dose RT in elderly patients with unresectable stage III NSCLC is not associated with significantly more toxicity than in non-elderly patients, resulting in a favourable long-term tumour control and survival. Despite more co-morbidity and a shorter survival in elderly patients, the age- and sex-adjusted relative survival is similar to that of non-elderly patients .

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