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Tanaka H, Ueda K, Hironaka A, Nakabe C, Ono T, Manabe Y, Kajima M, Fujimoto K, Shiinoki T. A Comparative Study of Radical Radiotherapy in Very Elderly and Non-Very Elderly Patients With Malignant Tumour Using Pairwise Matching. J Med Imaging Radiat Oncol 2025. [PMID: 40300879 DOI: 10.1111/1754-9485.13863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Revised: 04/01/2025] [Accepted: 04/17/2025] [Indexed: 05/01/2025]
Abstract
INTRODUCTION This study aimed to compare the outcomes and complications following radical radiotherapy between very elderly patients aged ≥ 90 years and non-very elderly patients using pairwise matching analysis. METHODS Data of patients who underwent radical radiotherapy at our hospital between January 2013 and March 2024 and those who were aged ≥ 90 years at the start of radical radiotherapy were extracted. Data of control patients were extracted by pairwise matching from patients aged < 90 years who underwent radical radiotherapy during the same period. Pairwise matching was performed using the following criteria: (i) cancer type, (ii) TNM classification, (iii) histological type, (iv) concurrent chemotherapy, (v) prescribed biological effective dose, (vi) performance status, (vii) sex and (viii) ability to walk. The local control (LC), cancer-specific survival (CSS) and overall survival (OS) rates were calculated from the date of completion of radiotherapy. RESULTS Forty patients from each group were analysed. There were no significant differences in LC, CSS or OS rates between the two groups. The completion rate of radiotherapy and the incidence rate of adverse events were not significantly different between the two groups. CONCLUSION In this study, there was no difference in the outcomes of radiotherapy between very elderly and non-very elderly patients. Our findings may aid clinicians in the treatment of nonagenarian patients.
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Affiliation(s)
- Hidekazu Tanaka
- Department of Radiation Oncology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Kazushi Ueda
- Department of Radiation Oncology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Akane Hironaka
- Department of Radiation Oncology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Chika Nakabe
- Department of Radiation Oncology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Taiki Ono
- Department of Radiation Oncology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Yuki Manabe
- Department of Radiation Oncology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Miki Kajima
- Department of Radiation Oncology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Koya Fujimoto
- Department of Radiation Oncology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Takehiro Shiinoki
- Department of Radiation Oncology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
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Xie Z, Zhang Y, Wei R, Li Y, Mei Z. Prognostic Nomograms for Elderly Patients with Small Cell Lung Cancer Brain Metastasis: A Surveillance, Epidemiology, and End Results Population-Based Study with Temporal External Validation. World Neurosurg 2024; 189:e632-e651. [PMID: 38945206 DOI: 10.1016/j.wneu.2024.06.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Accepted: 06/25/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE This study aimed to pinpoint independent predictors influencing overall survival (OS) and cancer-specific survival (CSS) in elderly patients with small cell lung cancer (SCLC) brain metastasis (BM), and to create and validate nomograms for OS and CSS prediction. METHODS Data from elderly SCLC BM patients were extracted out of the Surveillance, Epidemiology, and End Results database, including 1200 patients identified from 2010 and 2015 who were randomly allocated into a training set and an internal validation set at a proportion of 7:3, and 666 patients diagnosed between 2018 and 2020 as a temporal external validation set. Independent predictors for OS and CSS were determined through univariate Cox analysis, least absolute shrinkage and selection operator analysis, and multivariate Cox analysis sequentially. Nomograms for OS and CSS were constructed, and validated by the internal and temporal external validation sets. RESULTS Age, N stage, chemotherapy, and liver metastasis were determined as independent predictors of OS and CSS, while radiotherapy and surgery were not. Nomograms were constructed based on these independent predictors. The results of the receiver operator characteristic curves, the areas under the curve and calibration curve demonstrated that the nomograms exhibited commendable discriminative ability and calibration. Moreover, decision curve analysis, net reclassification improvement, and integrated discrimination improvement also suggested that the nomograms possessed superior clinical usefulness and predictive capability relative to the TNM system. CONCLUSIONS Prognostic nomograms for elderly patients with SCLC BM have been developed, demonstrating good performance in terms of accuracy, reliability, and practicality.
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Affiliation(s)
- Zongzhou Xie
- Department of Oncology, Haikou City People's Hospital, Haikou, Hainan, China
| | - Yingjie Zhang
- Department of Orthodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong, China
| | - Ruifu Wei
- Department of Oncology and Hematology, Dongfang People's Hospital, Dongfang, Hainan, China
| | - Yongfu Li
- Department of Oncology, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Zhenxin Mei
- Department of Oncology, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China.
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Cui R, Wang XL, Cao J. Implantation of computed tomography-guided high-dose-rate 192Ir brachytherapy in oldest old patients with advanced non-small cell lung cancer: A case report and literature review. Medicine (Baltimore) 2022; 101:e32450. [PMID: 36595988 PMCID: PMC9803449 DOI: 10.1097/md.0000000000032450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND With the increasing aging and the popularization of medical diagnosis, the growing number of oldest old with lung cancer needs to be focused on. Several medical and physiological challenges often accompanying the oldest old cancer patients make the choice of the optimal treatment daunting. The current research suggests that people who get adequate treatment can benefit, but it is worth discussing which treatment will benefit them more. High-dose-rate (HDR) 192Ir brachytherapy deserves attention in this context owing to its association with less trauma and reduced complications. CASE PRESENTATION An 86-years-old woman with a right glandular lung carcinoma presented with progressive lesions 11 months after chemotherapy. Because of her old age and poor performance status (eastern cooperative oncology group performance status 3), she received HDR 192Ir brachytherapy for her right lung lesion without any common complications, such as pneumothorax and hemorrhage. She continued on 0.25 g oral gefitinib each day after received brachytherapy treatment. The right lung lesion keeps a partial response until 18 months later now. CONCLUSION HDR 192Ir brachytherapy can potentially be used as a safe and effective choice for the oldest old with advanced non-small cell lung cancer. It can especially benefit cancer patients with concurrent chemotherapy or targeted therapy.
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Affiliation(s)
- Ran Cui
- Department of Oncology, The First People’s Hospital of Neijiang, Neijiang, Sichuan, China
| | - Xiu-Lan Wang
- Department of Oncology, The First People’s Hospital of Neijiang, Neijiang, Sichuan, China
| | - Jian Cao
- Department of Oncology, The First People’s Hospital of Neijiang, Neijiang, Sichuan, China
- * Correspondence: Jian Cao, Department of Oncology, The First People’s Hospital of Neijiang, Neijiang 641000, Sichuan, China (e-mail: )
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Willén L, Berglund A, Bergström S, Isaksson J, Bergqvist M, Wagenius G, Lambe M. Are older patients with non-small cell lung cancer receiving optimal care? A population-based study. Acta Oncol 2022; 61:309-317. [PMID: 34779354 DOI: 10.1080/0284186x.2021.2000637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Results from studies addressing age-related patterns of cancer care have found evidence of unjustified differences in management between younger and older patients. METHODS We examined associations between age and clinical presentation, management and mortality in patients diagnosed with non-small cell lung cancer (NSCLC) between 2002 and 2016. Analyses were adjusted for comorbidity and other factors that may have affected management decisions and outcomes. RESULTS The study population encompassed 40,026 patients with NSCLC. Stage at diagnosis did not differ between age groups ≤ 84. The diagnostic intensity was similar in age groups <80 years. In patients with stage IA-IIB disease and PS 0-2, surgery was more common in the youngest age groups and decreased with increasing age, and was rarely performed in those ≥ 85 years. The use of stereotactic body radiotherapy (SBRT) increased with age (≤69 years 5.4%; ≥85 years 35.8%). In patients with stage IIIA disease and PS 0-2, concurrent chemoradiotherapy was more common in younger patients (≤69 years 55.3%; ≥85 years 2.2%). In stage IA-IIIA disease, no major differences in treatment-related mortality was observed. In stage IIIB-IV and PS 0-2, chemotherapy was more common in patients <80 years. However, 58.1% of patients 80-84 years and 30.3% ≥ 85 years received treatment. In stage IA-IIIA, overall and cause-specific survival decreased with increasing age. No age-differences in survival were observed in patients with stage IIIB-IV NSCLC. CONCLUSION Treatments were readily given to older patients with metastatic disease, but to a lesser degree to those with early stage disease. Significant differences in cause specific survival were observed in early, but not late stage disease. Our findings underscore the importance of individualized assessment of health status and life expectancy. Our results indicate that older patients with early stage lung cancer to a higher extent should be considered for curative treatment.
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Affiliation(s)
- Linda Willén
- Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
- Department of Radiation Sciences and Oncology, Umeå University, Umeå, Sweden
- Department of Oncology, Gävle Hospital, Gävle, Sweden
| | | | - Stefan Bergström
- Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
- Department of Radiation Sciences and Oncology, Umeå University, Umeå, Sweden
- Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - Johan Isaksson
- Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
- Department of Pulmonary Medicine, Gävle Hospital, Gävle, Sweden
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Michael Bergqvist
- Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
- Department of Radiation Sciences and Oncology, Umeå University, Umeå, Sweden
- Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - Gunnar Wagenius
- Division of Oncology, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Regional Cancer Center Central Sweden, Uppsala, Sweden
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Kim D, Lee JW. Current Status of Lung Cancer and Surgery Based on Studies Using a Nationwide Database. J Chest Surg 2021; 55:1-9. [PMID: 34907096 PMCID: PMC8824654 DOI: 10.5090/jcs.21.105] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022] Open
Abstract
Lung cancer is a fatal disease, highlighting the importance of research on related topics, including surgery for lung cancer. However, systematic research analyzing surgery on a national scale is limited. This study aimed to investigate the research on lung cancer using nationwide data in South Korea and to analyze trends in lung cancer surgery, including its clinical implications. Published articles and data from the Korean National Health Insurance database were used. Although the incidence and mortality of lung cancer have been improving, it is predicted to be the most common and fatal type of cancer in South Korea in 2021. The number of surgical procedures for lung cancer is increasing, especially among women, those ≥76 years of age, residents of non-metropolitan cities, and middle-income patients. Lobectomy and sublobectomy, including segmentectomy, are increasingly common. However, the proportion of pneumonectomy relative to other procedures is not increasing. Surgery has shown a reasonable survival rate, especially after lobectomy, but survival remains poor in patients ≥76 years of age who undergo pneumonectomy. The frequency of lung cancer surgery is increasing concomitantly with various socioeconomic changes. Lobectomy has become increasingly common, and the clinical results of surgery are satisfactory. Further research on the changing composition of surgical candidates is required.
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Affiliation(s)
- Dohun Kim
- Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jung-Won Lee
- Department of Biochemistry, School of Medicine, Institute for Tumor Research, Chungbuk National University, Cheongju, Korea
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Pilleron S, Gower H, Janssen-Heijnen M, Signal VC, Gurney JK, Morris EJ, Cunningham R, Sarfati D. Patterns of age disparities in colon and lung cancer survival: a systematic narrative literature review. BMJ Open 2021; 11:e044239. [PMID: 33692182 PMCID: PMC7949400 DOI: 10.1136/bmjopen-2020-044239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To identify patterns of age disparities in cancer survival, using colon and lung cancer as exemplars. DESIGN Systematic review of the literature. DATA SOURCES We searched Embase, MEDLINE, Scopus and Web of Science through 18 December 2020. ELIGIBILITY CRITERIA We retained all original articles published in English including patients with colon or lung cancer. Eligible studies were required to be population-based, report survival across several age groups (of which at least one was over the age of 65) and at least one other characteristic (eg, sex, treatment). DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed the quality of included studies against selected evaluation domains from the QUIPS tool, and items concerning statistical reporting. We evaluated age disparities using the absolute difference in survival or mortality rates between the middle-aged group and the oldest age group, or by describing survival curves. RESULTS Out of 3047 references, we retained 59 studies (20 for colon, 34 for lung and 5 for both sites). Regardless of the cancer site, the included studies were highly heterogeneous and often of poor quality. The magnitude of age disparities in survival varied greatly by sex, ethnicity, socioeconomic status, stage at diagnosis, cancer site, and morphology, the number of nodes examined and treatment strategy. Although results were inconsistent for most characteristics, we consistently observed greater age disparities for women with lung cancer compared with men. Also, age disparities increased with more advanced stages for colon cancer and decreased with more advanced stages for lung cancer. CONCLUSIONS Although age is one of the most important prognostic factors in cancer survival, age disparities in colon and lung cancer survival have so far been understudied in population-based research. Further studies are needed to better understand age disparities in colon and lung cancer survival. PROSPERO REGISTRATION NUMBER CRD42020151402.
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Affiliation(s)
- Sophie Pilleron
- Department of Public Health, School of Medicine, University of Otago, Wellington, New Zealand
| | - Helen Gower
- Department of Surgery and Anaesthesia, Surgical Cancer Research Group, University of Otago, Wellington, New Zealand
| | - Maryska Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Epidemiology, Maastricht University Medical Centre+, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Virginia Claire Signal
- Department of Public Health, School of Medicine, University of Otago, Wellington, New Zealand
| | - Jason K Gurney
- Department of Public Health, School of Medicine, University of Otago, Wellington, New Zealand
| | - Eva Ja Morris
- Nuffield Department of Population Health, University of Oxford, Big Data Institute, Oxford, UK
| | - Ruth Cunningham
- Department of Public Health, School of Medicine, University of Otago, Wellington, New Zealand
| | - Diana Sarfati
- New Zealand Cancer Control Agency, Wellington, New Zealand
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Dotsu Y, Fukuda M, Honda N, Gyotoku H, Kohno Y, Suyama T, Umeyama Y, Taniguchi H, Takemoto S, Yamaguchi H, Miyazaki T, Sakamoto N, Obase Y, Ikeda H, Ashizawa K, Mukae H. Dabrafenib and trametinib therapy in an elderly patient with non-small cell lung cancer harboring the BRAF V600E mutation. Thorac Cancer 2020; 12:272-276. [PMID: 33215864 PMCID: PMC7812073 DOI: 10.1111/1759-7714.13756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/04/2020] [Accepted: 11/08/2020] [Indexed: 11/29/2022] Open
Abstract
Dabrafenib and trametinib therapy for BRAF V600E‐mutant non‐small cell lung cancer (NSCLC) has demonstrated strong antitumor effects in clinical trials and has been approved for use in clinical practice. However, the efficacy and safety of this combination therapy in elderly patients remain unclear. An 86‐year‐old male patient, who had been diagnosed with lung adenocarcinoma with the BRAF V600E mutation, received dabrafenib and trametinib combination chemotherapy. The tumor shrunk rapidly; however, therapy was discontinued after 40 days because adverse events (hypoalbuminemia, peripheral edema, and pneumonia) developed. Although this targeted combination therapy seemed to cause relatively severe adverse events compared with single‐agent targeted therapy in this “oldest old” elderly patient, the marked tumor shrinkage prolonged the patient's life and helped him to maintain a good general condition. Active targeted therapy may therefore be considered with appropriate drug dose reduction instead of conservative treatment, even if a patient is extremely old.
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Affiliation(s)
- Yosuke Dotsu
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Minoru Fukuda
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Clinical Oncology Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Noritaka Honda
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Gyotoku
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshihisa Kohno
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Takayuki Suyama
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yasuhiro Umeyama
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hirokazu Taniguchi
- Molecular Pharmacology Program and Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Shinnosuke Takemoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroyuki Yamaguchi
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Taiga Miyazaki
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yasushi Obase
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroaki Ikeda
- Department of Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Kazuto Ashizawa
- Clinical Oncology Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Octogenarians treated for thoracic and lung cancers: Impact of comprehensive geriatric assessment. J Geriatr Oncol 2020; 12:402-409. [PMID: 33097456 DOI: 10.1016/j.jgo.2020.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/30/2020] [Accepted: 10/07/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Lung cancer affects older and older old adults and is the leading cause of death by cancer. Comprehensive Geriatric Assessment (CGA) is recommended before and during cancer treatment to guide therapy management in this population. METHODS This study was conducted between September 2015 and January 2019 at Marseille University Hospital (AP-HM). During this period, all consecutive outpatients 70 years or older referred for a CGA before initiation of lung cancer treatment were enrolled. The objective of this study was to compare lung and thoracic cancer management of octogenarians (≥80 years) and their geriatric profile versus patients aged 70 to 79 years (<80 years). FINDINGS In our study, 228 patients were recruited. The median age was 78.7 ± 5 years. There were 94 octogenarians (41.2%), 36.2% of them were diagnosed with stage IV neoplasm and the most common treatment was chemotherapy (43.6%). The logistic regression analysis highlights that handgrip strength was the most commonly impaired domain (OR 2.3; 95% CI [1.3-4.3]) in octogenarians and that they are more likely than their younger counterparts to be treated by targeted therapy (OR 9.8; 95% CI [1.0-92.9]). Overall survival (OS) was similar in both age groups (log rank = 0,95). INTERPRETATION In our study, octogenarians and patients <80 years had equivalent survival, across the different thoracic cancer treatments and tumor stages. Measure of muscle strength in CGA could be very useful in a clinical setting to help improve the management of older old patients treated for lung or thoracic cancer.
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Surgical results and prognosis of lung cancer in elderly Japanese patients aged over 85 years: comparison with patients aged 80-84 years. Gen Thorac Cardiovasc Surg 2020; 69:67-75. [PMID: 32627148 DOI: 10.1007/s11748-020-01426-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/27/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE With the increase in lung cancer patients over 80 years of age, lobectomy with mediastinal lymph node dissection is often performed in patients in a good general condition. However, the age limit for this procedure has not yet been determined. In this study, we examined the safety, therapeutic results, and prognosis of surgical treatment for lung cancer patients over 85 years of age. METHODS Among the 4446 lung cancer patients who underwent surgery at our hospital from January 1997 to March 2019, we assessed 320 patients (7.2%, Group A, aged 80-84 years) and 74 patients (1.7%, Group B, aged over 85 years). RESULTS The median age of the patients in Group B was 86 years. Compared to Group A, Group B had significantly more patients with a history of ischemic heart disease, lower pack-year smoking, and lobectomy and lobectomy less resection (reduced surgery), and a shorter operation time (P < 0.05). There was no significant difference between the two groups in terms of postoperative complications. There was no significant difference in survival rate and prognosis between the two groups, and the 2-, 3-, and 5-year survival rates were 79.0%, 74.7%, and 53.6%, respectively, in Group B. In Group B sex (female) and early stage of cancer were independent prognostic factors of non-small cell lung cancer (stage I). CONCLUSIONS In a limited number of patients, surgical resection in patients aged over 85 years was safely performed, and the survival of these patients was comparable to those aged 80-84 years.
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Driessen E, Detillon D, Bootsma G, De Ruysscher D, Veen E, Aarts M, Janssen-Heijnen M. Population-based patterns of treatment and survival for patients with stage I and II non-small cell lung cancer aged 65-74 years and 75 years or older. J Geriatr Oncol 2019; 10:547-554. [PMID: 30876833 DOI: 10.1016/j.jgo.2019.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/24/2019] [Accepted: 03/01/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Insights regarding utilization and survival of surgery and radiotherapy (stereotactic body radiotherapy (SBRT) or conventional radiotherapy (RT)) are lacking for older patients with stage I and II non-small cell lung cancer (NSCLC) in clinical practice. METHODS Data from the Netherlands Cancer Registry were retrieved for patients ≥65 years with clinical stage I-II NSCLC in 2010-2015. Descriptive analyses, overall survival (OS), and cox regression were stratified for stage I (n = 8742) and II (n = 3439) and compared age groups (65-74 years vs ≥75 years). RESULTS Patients aged 65-74 underwent surgery significantly more often compared to those aged ≥75 (stage I 55% vs 27%; stage II: 65% vs 35%), and received SBRT less often (I: 29% vs 42%; II: 5% vs 11%), conventional RT less often (I: 6% vs 11%; II 10% vs 24%) and best supportive care alone less often (BSC, I: 8% vs 19%; II: 9% vs 25%). One-year OS was significantly higher in patients aged 65-74 compared to those aged ≥75 (I: 87% vs 78%; II: 74% vs 60%); as was five-year OS (I: 49% vs 31%; II: 36% vs 18%). After adjustment for gender, histology, stage, treatment, and comorbidity, hazard ratio (HR) of death was higher for patients aged ≥75 compared to those aged 65-74 (I: HR 1.3, 95% confidence interval (CI) 1.1-1.5; II: HR 1.3 95%CI 1.1-1.7). CONCLUSION Patients aged ≥75 with stage I-II NSCLC had poorer OS, underwent surgery less often, and received SBRT, conventional RT, and BSC more often than patients aged 65-74. In both stages, one-year OS within age groups was similar for surgery and SBRT. However, long-term OS adjusted for prognostic factors was superior for surgery compared to SBRT and remained poorer for those aged ≥75. Prospective research should focus on predictive characteristics for treatment selection and patient-centered outcomes.
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Affiliation(s)
- Elisabeth Driessen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, Maastricht University Medical Centre+, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands.
| | | | - Gerbern Bootsma
- Department of Pulmonology, Zuyderland Medical Centre, Heerlen, the Netherlands.
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Eelco Veen
- Department of Surgery, Amphia Hospital, Breda, the Netherlands.
| | - Mieke Aarts
- Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands.
| | - Maryska Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, Maastricht University Medical Centre+, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands.
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Stone E, Rankin N, Kerr S, Fong K, Currow DC, Phillips J, Connon T, Zhang L, Shaw T. Does presentation at multidisciplinary team meetings improve lung cancer survival? Findings from a consecutive cohort study. Lung Cancer 2018; 124:199-204. [PMID: 30268461 DOI: 10.1016/j.lungcan.2018.07.032] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 07/13/2018] [Accepted: 07/17/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Multidisciplinary team (MDT) presentation in lung cancer has the potential to improve longterm outcomes, although this varies between studies. This study aims to evaluate outcomes including survival, according to MDT presentation and to explore the utility of data obtained from local clinical sources. PATIENTS AND METHODS Prospective cases of lung cancer recorded in our institution's cancer registry were analyzed according to MDT presentation for patient and tumour characteristics, adjusted survival and referral to palliative care. RESULTS 1197 cases were included, 295 (24.6%) with MDT presentation and 902 (75.4%) without. 60% of patients were male with median (IQR) age at diagnosis of 70 years (62-78). Histopathology distribution (non-small cell lung cancer and small-cell lung cancer) was similar between the two groups. Compared with the non-MDT group, the MDT group had (1) ECOG score recorded more often (71.9% vs. 47.6%), (2) higher proportion of ECOG 0 cases (31.2% vs. 11.9%) and ECOG 1 cases (28.8% vs. 20.3%), (3) higher proportion of early stage disease (stage I - 23.1% vs. 9.7% stage II - 10.2% vs. 4.8%, stage IIIA - 14.6% vs 6.3%) and (4) lower proportion of metastatic disease (stage IV - 39.3% vs. 56.1%). Referral to palliative care was incompletely recorded in both groups (MDT: n = 116/295, 39.3%; non-MDT: n = 430, 47.7%) but did not differ significantly for stage IV cases. Survival analyzed by stage was greater in the MDT group at 1, 2 and 5 years for all stages except stage IIIB at 1 year post-diagnosis. Adjusted survival analysis for the entire cohort showed improved survival at 5 years for the MDT group (HR 0.7 (0.58-0.85), p < 0.001). CONCLUSION MDT presentation is associated with improved adjusted survival for lung cancer in this single institutional cohort in an analysis of local clinical cancer registry data.
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Affiliation(s)
- Emily Stone
- St Vincent's Hospital Thoracic Medicine and Cancer Services, Kinghorn Cancer Centre, Australia; St Vincent's Clinical School, UNSW, Australia; Faculty of Medicine, University of Sydney, Australia.
| | - Nicole Rankin
- Cancer Council NSW, Cancer Research Division University of Sydney, Sydney Health Partners, Office of the Pro-Vice Chancellor, Research in association with Charles Perkins Centre, University of Sydney, Faculty of Science, School of Psychology, Australia
| | | | - Kwun Fong
- UQ Thoracic Research Centre, The Prince Charles Hospital, Brisbane QLD, Australia
| | - David C Currow
- IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
| | - Jane Phillips
- IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
| | | | - Lorena Zhang
- Royal North Shore Hospital, Reserve Rd, St Leonards NSW 2065, Australia
| | - Tim Shaw
- University of Sydney, Charles Perkins Centre, Australia
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