International Journal of Radiation Oncology*Biology*Physics
Clinical investigation: lungDo age and comorbidity impact treatment allocation and outcomes in limited stage small-cell lung cancer? a community-based population analysis
Introduction
Management of limited stage small-cell lung cancer (L-SCLC) has become more defined in the last decade, with randomized controlled trials (RCTs) demonstrating improved local control and survival with combined modality chemoradiotherapy (CRT) with multiagent chemotherapy (1), thoracic irradiation (TI) 2, 3, and prophylactic cranial irradiation (PCI) for complete responders (4). Despite initial response rates to CRT of approximately 80%, median survival remains modest at 12–24 months 1, 2, 3, 4, 5, 6, 7, 8. Incidence and mortality of SCLC increase with age (9, but the prognostic significance of age in L-SCLC is unclear. Results from clinical trials, which have accrued few subjects 65 years and older (10), cannot be readily extrapolated to the elderly patients with intercurrent medical problems frequently encountered in community practice. This study analyzed the effects of age and comorbidity on treatment delivery and outcomes in a population-based cohort of L-SCLC patients referred to a regional cancer center.
Section snippets
Methods and materials
The British Columbia (BC) Cancer Agency database was used to identify patients referred to the BC Cancer Agency, Vancouver Island Centre, between January 1, 1991 and December 31, 1999, with L-SCLC. Patient records were retrospectively reviewed to obtain data on patient characteristics, treatment, and clinical outcomes. Among 189 patients identified, 15 patients were excluded because they did not have L-SCLC (n = 13) or their case records could not be located (n = 2). The remaining 174 patients
Results
In this study cohort of 174 patients with L-SCLC, the median age was 68 years (range 35–86 years). Thirty-two percent (n = 55), 43% (n = 76), and 25% (n = 43) of these patients were ages <65, 65–74, and ≥75 years at diagnosis, respectively. At the time of analysis, 152 (87%) were deceased. Median follow-up time for patients alive was 52 months (range 10–92 months). Three patients were lost to follow-up at 10 months, 20 months, and 39 months, respectively.
Because of this study’s long accrual
Discussion
This analysis of a community-based cohort with L-SCLC has identified significant variations in patient and treatment characteristics according to age. Response and survival rates were lower with increased age and comorbidity; however, age and comorbidity were not independent factors affecting these unfavorable outcomes.
The caveat in extrapolating results from L-SCLC RCTs to the general population is underscored by the observations that, although most RCTs do not specifically exclude older
Conclusion
This study has confirmed that patient characteristics of a community-based cohort of L-SCLC patients differed from those typically enrolled in RCTs. Performance status declined and comorbidity increased significantly with advancing age. Elderly patients had less complete staging and received less intensive chemoradiation and PCI. With increasing age, response rates and overall survival significantly declined. Age and comorbidity, however, did not emerge as independent prognostic factors
References (31)
- et al.
A new method of classifying comorbidity in longitudinal studiesDevelopment and validation
J Chron Dis
(1987) - et al.
Retrospective review of chemotherapy for small cell lung cancer in the elderly: Does the ends justify the means?
Eur J Cancer
(1991) - et al.
Comorbidity, and KPS are independent prognostic factors in stage I non small cell lung cancer
Int J Radiat Oncol Biol Phys
(2002) Influence of age and comorbidities on the chemotherapeutic management of lung cancer
Lung Cancer
(2001)- et al.
Prophylactic cranial irradiation is indicated following complete response to induction therapy in small cell lung cancerResults of a multicentre randomised trial
Eur J Cancer
(1997) - et al.
Determinants of improved outcome in small-cell lung cancerAn analysis of the 2,580-patient Southwest Oncology Group database
J Clin Oncol
(1990) - et al.
Does thoracic irradiation improve survival and local control in limited-stage small cell carcinoma of the lung? A meta-analysis
J Clin Oncol
(1992) - et al.
A meta-analysis of thoracic radiotherapy for small cell lung cancer
N Engl J Med
(1992) - et al.
Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission
N Engl J Med
(1999) - et al.
Prognostic factors in small cell carcinoma of the lungAn analysis of 1521 patients
J Clin Oncol
(1989)
Prognostic factors for patients with small cell lung cancer
Cancer
The importance of timing for thoracic irradiation in the combined modality treatment of limited stage small cell lung cancer
J Clin Oncol
Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated with concurrently with cisplatin and etoposide
N Engl J Med
Underrepresentation of patients 65 years or older in cancer treatment trials
N Engl J Med
Cited by (134)
Social vulnerability and lung malignancy mortality
2023, Journal of Cancer PolicyComorbidity in limited disease small-cell lung cancer: Age-adjusted Charlson comorbidity index and its association with overall survival following chemoradiotherapy
2023, Clinical and Translational Radiation OncologyRacial and Other Healthcare Disparities in Patients With Extensive-Stage SCLC
2021, JTO Clinical and Research Reports