Cavitating squamous cell lung carcinoma-distinct entity or not? Analysis of radiologic, histologic, and clinical features

Bronchoscopically-visible massive central airway cancer cavitation is associated with metastatic disease, lack of actionable mutations and poor prognosis: a case series

Cavitating lung tumors occur in approximately 10-15% of the patients, are more commonly associated with squamous histology, and are typically located in the lung parenchyma. Herein we describe an exceedingly rare series of 5 patients, 4 of whom treatment-naïve, whose tumor caused the disruption of the normal airway anatomy at the level of lobar or segmental bronchi, leading to the formation of an endoscopically-visible cavity which ended up in the lung parenchyma or even into the pleural space. Sex (3 males, 2 females), smoking habit (2 never smokers, 2 former smokers, 1 current smoker), and histology (3 adenocarcinoma, 2 squamous cell carcinoma) were heterogeneous, but the 4 patients treatment-naïve presented with metastatic disease, poor ECOG performance status, similar clinical complaints of long duration, and lack of actionable mutations. The only patient who exhibited a meaningful response to treatment had the lowest symptoms' duration, the smallest size of the cavitated mass, and the best performance status at the time of diagnosis. This series provides the first comprehensive description of a rare presentation of lung cancer characterized by similar clinical complaints, delayed diagnosis and poor prognosis.

Small-Cell Lung Cancer Cavities: Primary or Secondary?

Although non-small-cell lung cancer occasionally presents as cavitary lesions, it is rare for small-cell lung cancer (SCLC) to present or progress in such a manner. If a cavitary lesion is seen in the setting of small-cell lung carcinoma, infectious etiologies must be excluded first. We present the case of a 43-year-old man with refractory SCLC that progressed despite two lines of therapy, and who was ultimately found to have recurrent adenopathy and numerous widespread cavitary lung nodules. Fine-needle aspiration of a hilar lymph node revealed extensively necrotic SCLC, while bronchoalveolar cultures grew Aspergillus fumigatus and Candida albicans. The patient was subsequently treated with voriconazole; however, despite these measures, his overall clinical course deteriorated and the patient ultimately succumbed to his illness. Aspergillosis is a major cause of cavitary lung lesions, especially in immunocompromised patients. Our patient with refractory stage four SCLC was found to have several cavitary lung lesions. Before assuming that cavitary lesions are neoplastic, evaluation for aspergillosis should be conducted, particularly in SCLC patients. Although invasive fungal infections are often missed, it may be prudent to conduct such testing because aspergillosis is a treatable condition and the treatment can improve a patient’s hospitalization and overall clinical course.

Timeliness of lung cancer diagnosis and treatment: a single-center experience

Background

Lung cancer is the number one cause of cancer death in America. Timely and appropriate care is critical in the management of lung cancer. We retrospectively reviewed our experience at the University of Kentucky to determine whether there were delays from initial presentation to diagnosis and from diagnosis to treatment. Furthermore, if delays existed, whether they affected overall survival and what factors contributed to these holdups in patient care.

Methods

This was a retrospective review of all patients who were diagnosed with lung cancer at the University of Kentucky between 2014 and 2017, including only those newly diagnosed at our institution and excluding patients who were diagnosed at other hospitals as well as patients with cancer recurrence. Out of a cohort of 3588 patients, only 517 were included.

Results

The average time between presentation and diagnosis was 43 days, and 86.7% of patients were diagnosed within 60 days. The average time to treatment from diagnosis was 27.5 days with 77.7% of patients being treated with either surgery, chemotherapy, and/or radiation within 42 days.

Conclusion

The majority of our patients were diagnosed and treated within the recommended time. The 13.3% and 22.3% of patients who did not fall within this timeframe were delayed due to personal reasons, comorbidities, and/or “watchful waiting”. Mortality seemed to be unaffected by any delays in diagnosis or treatment. This analysis is the first step in understanding the challenges in patient care, and can be a tool to institute programs to help patients obtain necessary care.

Prognostic factors for surgically resected non-small cell lung cancer with cavity formation

Background

Small pulmonary nodules have been detected frequently by computed tomography (CT). Lung cancers with cavity formation are also easily detected. There are a few reports focused on the cavity wall, although cancer cells exist along the cavity wall, not inside. We evaluated the impact of cavity wall thickness on prognosis and assessed the clinicopathological features in non-small cell lung cancer (NSCLC) with cavity formation.

Methods

Between 2005 and 2011, 1,313 patients underwent complete resection for NSCLC. Of these cases, we reviewed 65 patients (5.0%) diagnosed with NSCLC with cavity formation by chest CT. We classified the patients into three groups based on the maximum cavity wall thickness, namely, ≤4 mm (Group 1, 8 patients), >4 and ≤15 mm (Group 2, 33 patients), and >15 mm (Group 3, 24 patients).

Results

The number of patients with pathological whole tumor size >3 cm was 2 (25%) in Group 1, 17 (52%) in Group 2, and 23 (96%) in Group 3 (P<0.001). Cases with lymph node metastasis were 0 (0%) in Group 1, 5 (15%) in Group 2, and 10 (42%) in Group 3 (P=0.016). The 5-year overall survival (OS) rates were 100% in Group 1, 84.0% in Group 2, and 52.0% in Group 3, with significant differences between Group 1 and Group 3 (P=0.044) and between Group 2 and Group 3 (P=0.034). In univariate analysis, neither whole tumor size nor lymph node metastasis was a prognostic factor for OS (P=0.51, P=0.27). Only cavity wall thickness was a significant prognostic factor by multivariate analysis (P=0.009).

Conclusions

Maximum cavity wall thickness was an important prognostic factor in NSCLCs with cavity formation, comparable with other established prognostic factors.

Immunoglobulin G4-Related Lung Disease Presenting as Lung Cavitating Mass and Mimicking Lung Cancer

Immunoglobulin G4-related lung disease (IgG4-RLD) is a disease in which abundant activated IgG4-positive plasma cells and lymphocytes infiltrate lung tissues with high 18F-fluorodeoxyglucose uptake. Although various forms of radiologic features of IgG4-RLD have been reported, cavitating mass is a rare imaging feature and should be differentiated from cancer. Therefore, in this article, we report two cases both with unprovoked cough, bloody sputum and presenting quite similar cavitating lesions with high 18F-fluorodeoxyglucose uptake on positron emission tomography/ computed tomography, one of which diagnosed as IgG4-RLD and the other as lung cancer based on biopsy eventually. The awareness of the imaging features of IgG4-RLD and lung cancer described in the present study may help physicians to distinguish one from the other. IgG4-RLD should be considered in the differential diagnosis of cavitary lung lesions.

Low tumour cell content in a lung tumour bank: implications for molecular characterisation

Lung cancer encompasses multiple malignant epithelial tumour types, each with specific targetable, potentially actionable mutations, such that precision management mandates accurate tumour typing. Molecular characterisation studies require high tumour cell content and low necrosis content, yet lung cancers are frequently a heterogeneous mixture of tumour and stromal cells. We hypothesised that there may be systematic differences in tumour cell content according to histological subtype, and that this may have implications for tumour banks as a resource for comprehensive molecular characterisation studies in lung cancer. To investigate this, we estimated tumour cell and necrosis content of 4267 samples resected from 752 primary lung tumour specimens contributed to a lung tissue bank. We found that banked lung cancer samples had low tumour cell content (33%) generally, although it was higher in carcinoids (77.5%) than other lung cancer subtypes. Tumour cells comprise a variable and often small component of banked resected tumour samples, and are accompanied by stromal reaction, inflammation, fibrosis, and normal structures. This has implications for the adequacy of unselected tumour bank samples for diagnostic and molecular investigations, and further research is needed to determine whether tumour cell content has a significant impact on analytical results in studies using tissue from tumour bank resources.

Clinical significance of tumor cavitation in surgically resected early-stage primary lung cancer

OBJECTIVES

The prognostic impact of tumor cavitation is unclear in patients with early-stage primary lung cancer. The aim of the present study was to examine the clinicopathological features and prognoses of patients with pathological stage I-IIA (p-stage I-IIA) primary lung cancers harboring tumor cavitation. This study was conducted according to the eighth edition of the TNM classification for lung cancer.

MATERIALS AND METHODS

We examined 602 patients with p-stage I-IIA primary lung cancer out of 890 patients who underwent pulmonary resection from January 2007 through March 2014 and searched for the presence of tumor cavitation, which is defined as the presence of air space within the primary tumor.

RESULTS

A total of 59 out of the 602 patients had tumor cavitation (10%). Compared with patients without tumor cavitation, those with tumor cavitation had a significantly higher frequency of the following characteristics: high serum carcinoembryonic antigen (CEA) level (≥5ng/ml, p=0.027), interstitial pneumonia (p=0.0001), high SUVmax value on FDG-PET scan (≥4.2, p=0.023), tumors located in the lower lobe (p=0.024), large tumor size (>3cm, p=0.002), vascular invasion (66% vs 17%, p<0.0001) and non-adenocarcinoma histology (p=0.025). The overall survival period of patients with tumor cavitation was significantly shorter than that of patients without tumor cavitation (log-rank test: p<0.0001, 5-year OS rate: 56% vs 81%). Tumor cavitation was found to be an independent and significant factor associated with poor prognosis in the multivariate analysis (hazard ratio: 1.76, 95% confidence interval: 1.02-3.10, p=0.042).

CONCLUSIONS

Tumor cavitation is an independent factor for poor prognosis in patients with resected p-stage I-IIA primary lung cancer. Based on our analyses, patients with tumor cavitation should be regarded as a separate cohort that requires more intensive follow-up.

Significance of different response evaluation criteria in predicting progression-free survival of lung cancer with certain imaging characteristics

Background

Certain radiographic signs of a treatment response, such as cavitation, changes in density, or tumor change along a short axis, are not considered by Response Evaluation Criteria in Solid Tumors (RECIST). This study evaluates what additional prognostic information can be obtained by including these criteria in tumor assessment.

Methods

Data of 105 patients were included. Tumor cavitation was observed in 51 patients at baseline. An additional 23 patients developed tumor cavitation during treatment. A change in tumor density was the only radiographic treatment response observed in 22 patients. The only measureable treatment response in nine patients was a decrease along the short axis size of the tumor. Tumor response was assessed using various criteria.

Results

In patients with basic tumor cavitation, RECIST1.1 scores accurately predicted differences in progression‐free survival (PFS; P = 0.076) while modified (m) RECIST did not (P = 0.550). mRECIST detected a significant difference between PFS in patients with post‐therapeutic cavitation with different responses, but no significant difference using RECIST1.1 (P = 0.004 vs. P = 0.477). In patients with only tumor density changes, there was no significant difference in PFS when either RECIST1.1 or density criteria were used (P = 0.419). In patients with a change in size along the tumor's short axis, short axis criteria could predict significant difference in PFS (P = 0.004).

Conclusions

RECIST1.1 provides the best assessment of tumor response and prediction of PFS in patients with basic tumor cavitation. mRECIST provides better PFS prognostic information in patients with post‐therapeutic cavitation. Short axis criteria provides better PFS prognostic information in patients with changes in the short axis of tumor diameter. Changes in tumor density were not a useful prognostic sign.

Are there radiographic, metabolic, and prognostic differences between cavitary and noncavitary nonsmall cell lung carcinoma? A retrospective fluorodeoxyglucose positron emission tomography/computed tomography study

AIMS:

The prognosis of nonsmall cell lung cancer with cavitation (NSCLC-c) is not well-known. We compared the positron emission tomography/computed tomography (PET/CT) findings and survival data of patients with NSCLC-c patients with those without cavitation (NSCLC-nc).

METHODS:

Between 7/2004 and 6/2007, cavitary lung lesions were identified in 46/248 patients undergoing fluorodeoxyglucose (FDG) PET/CT for lung nodule characterization or lung cancer staging. Within the same period, 40 of 202 patients with NSCLC-nc were randomly selected for comparison. The primary was assessed by location, size, cell type, and standardized uptake value (SUV). Disease stage was determined according to American Joint Committee on Cancer guidelines for lung cancer. Kaplan–Meier method was used for survival analysis and Cox regression to assess the effect of clinical and imaging variables on survival.

RESULTS:

NSCLC-c was found in 87% of patients that had a cavitary lung lesion at PET/CT. Squamous cell carcinoma, primary size and primary-to-liver SUV ratio differed significantly between NSCLC-c and NSCLC-nc, whereas age, gender, primary location, primary SUV, type of treatment, and disease stage did not. Median survival and overall 5-year survival were 19 months and 24% for NSCLC-c, and 31 months and 31% for NSCLC-nc, P = 0.23. Disease stage was the only predictor of survival.

CONCLUSION:

Cavitary lung lesions in patients undergoing FDG PET/CT harbor a significant risk for cancer. NSCLC-c is associated with squamous cell carcinoma, larger size, and greater FDG metabolism compared with NSCLC-nc, although these variables may not be predictive of survival. Nonetheless, PET/CT contributes to accurate staging and has an indirect impact on prognosis.

Toxicity and efficacy of chemotherapy for non-small cell lung cancer with cavitary lesions

BACKGROUND

Concurrent chemoradiation in stage III non-small cell lung cancer (NSCLC) patients with cavitary lesions is reported to cause serious lung complications and is a predictor of poor survival. However, the efficacy and toxicity associated with chemotherapy for advanced NSCLC patients with cavitary lesions is not clear. We investigated the toxicities, particularly hemoptysis and cavity infection, and efficacy associated with chemotherapy for NSCLC patients with cavitary lesions.

METHODS

We retrospectively reviewed consecutive patients who received first-line chemotherapy, including platinum-based chemotherapy, single-agent chemotherapy, or epidermal growth factor receptor-tyrosine kinase inhibitors, at our institution between January 2008 and December 2010.

RESULTS

We found tumor cavitation prior to treatment in 23 of 415 NSCLC patients (5.5%). The response rate of all the patients was 30%, and the median survival time (MST) was 8.9 months. The MST of the 15 patients treated with platinum-based chemotherapy was 11 months. Grade 1 bronchopulmonary hemorrhage occurred in 2 patients. Grade 3 cavitary infection occurred in 2 patients, resulting in the discontinuation of chemotherapy.

CONCLUSIONS

This study indicates that the toxicity of chemotherapy for NSCLC patients with cavitary lesions is tolerable; however, the development of cavitary infection should be carefully considered. In addition, this study suggests that the efficacy of chemotherapy for NSCLC patients with cavitary lesions is similar to the response rates reported in the literature; however, the survival of these patients may be worse than that for general NSCLC patients.

Tumor cavitation among lung cancer patients receiving first-line chemotherapy at a tertiary care centre in India: association with histology and overall survival

Clinical significance of tumor cavitation (TC) prior to and following first-line chemotherapy of lung cancer is unclear. An evaluation of the incidence and prognostic role of TC among treatment naive lung cancer patients undergoing chemotherapy at a tertiary care institute in North India was undertaken. Retrospective data analysis and radiological review of newly diagnosed lung cancer patients initiated on chemotherapy over a 2-year period were carried out. Demographic characteristics and overall survival (OS) were compared between patients with and without TC at baseline. Patients who received 3 or more cycles of chemotherapy were included in analysis for response rates and new onset TC. Overall, 27 (7.8 %) of 347 patients had baseline TC. Among 271 non-small cell lung cancer (NSCLC) patients with (n = 26) and without (n = 245) baseline TC, histology was the only demographic characteristic that differed significantly [squamous 76.9 vs. 46.9 %; p = 0.004]. Majority (82.7 %) of NSCLC patients had advanced (stage IIIB/IV) disease. NSCLC patients with and without baseline TC alive at 6 months, 1 and 2 years were 34.6 versus 53.9 %, 11.5 versus 25.7 % and 3.8 versus 7.8 %, respectively. NSCLC patients with baseline TC had shorter median OS than those without (174 days [95 % confidence interval (CI) 106-242 days] vs. 235 days [95 % CI 207-263 days]). On multivariate Cox proportional hazard analysis, age [hazard ratio (HR) = 1.02, 95 % CI 1.01-1.04] and baseline TC [HR = 1.66, 95 % CI 1.03-2.69] were found significant. Response rates were similar between the two groups. Patients with TC after chemotherapy differed from those without in frequency of squamous histology (77.8 vs. 38.9 %; p < 0.001) and presence of metastatic disease (19.4 vs. 40.9 %; p = 0.016). Squamous histology has a significant association with presence of baseline TC and of new onset TC after chemotherapy. Presence of baseline TC has an independent association with shorter OS among NSCLC patients undergoing first-line chemotherapy.

Imaging characteristics of stage I non-small cell lung cancer on CT and FDG-PET: relationship with epidermal growth factor receptor protein expression status and survival

OBJECTIVE

To identify CT and FDG-PET features associated with epidermal growth factor receptor (EGFR) protein overexpression, and to evaluate whether imaging features and EGFR-overexpression can help predict clinical outcome.

MATERIALS AND METHODS

In 214 patients (M : F = 129 : 85; mean age, 63.2) who underwent curative resection of stage I non-small cell lung cancer, EGFR protein expression status was determined through immunohistochemical analysis. Imaging characteristics on CT and FDG-PET was assessed in relation to EGFR-overexpression. Imaging features and EGFR-overexpression were also evaluated for clinical outcome by using the Cox proportional hazards model.

RESULTS

EGFR-overexpression was found in 51 patients (23.8%). It was significantly more frequent in tumors with an SUV(max) > 5.0 (p < 0.0001), diameter > 2.43 cm (p < 0.0001), and with ground glass opacity ≤ 50% (p = 0.0073). SUV(max) > 5.0 (OR, 3.113; 95% CI, 1.375-7.049; p = 0.006) and diameter > 2.43 cm (OR, 2.799; 95% CI, 1.285-6.095; p = 0.010) were independent predictors of EGFR overexpression. Multivariate analysis showed that SUV(max) > 4.0 (hazard ratio, 10.660; 95% CI, 1.370-82.966; p = 0.024), and the presence of cavitation within a tumor (hazard ratio, 3.122; 95% CI, 1.143-8.532; p = 0.026) were factors associated with poor prognosis.

CONCLUSION

EGFR-overexpression is associated with high SUV(max), large tumor diameter, and small GGO proportion. CT and FDG-PET findings, which are closely related to EGFR overexpression, can be valuable in the prediction of clinical outcome.

Retrospective evaluation of the clinical and radiographic risk factors associated with severe pulmonary hemorrhage in first-line advanced, unresectable non-small-cell lung cancer treated with Carboplatin and Paclitaxel plus bevacizumab

PURPOSE

Severe (grade >or= 3) pulmonary hemorrhage (PH) in advanced non-small-cell lung cancer was observed in two prospective, randomized, phase II (N = 99) and phase III (N = 878) trials of bevacizumab plus carboplatin and paclitaxel. Retrospective case-control and cohort analyses were conducted to identify associated radiographic and clinical risk factors for PH.

PATIENTS AND METHODS

Six patients with PH from the phase II trial, 15 potential PH patients with hemorrhage at any site from the phase III trial, and their matched controls were evaluated with review of baseline and on-treatment radiographs by an independent radiology facility, blinded to patient/control status. Patients with severe (grade >or= 3) PH from each trial were matched with up to three controls based on sex, age group, histology (phase II), or sex and age group (phase III).

RESULTS

Seven PH patients in the phase III trial were identified as severe PH. Six of the patients were early onset (occurred < 150 days of initiating bevacizumab) and one was late onset. Baseline tumor cavitation, not tumor location, was identified as the only potential risk factor for patients with early onset. Combined analysis of severe PH patients from the phase II and phase III trials (n = 13), compared with their pooled matched controls (n = 42), did not identify any additional baseline radiographic or clinical variables associated with PH.

CONCLUSION

PH was an uncommon event. Based on these analyses, baseline tumor cavitation may be a potential risk factor for PH. No other baseline clinical variables were predictive for PH although the number of events was small.

18F-fluoro-2-deoxy-D-glucose standardized uptake value in cavitating non-small-cell lung carcinoma

PURPOSE

Cavitation in lung tumours has been considered as a specific clinical subentity related to worse prognosis and reduced survival. This study was performed to assess glycolysis as maximum standardized uptake value (SUVmax) on F-fluoro-2-deoxy-D-glucose PET imaging, a known prognostic factor in lung cancer and an index of tumour aggression in cavitated tumours.

MATERIALS AND METHODS

Thirty-one patients with biopsy-proved, cavitated, non-small cell lung cancer (NSCLC) underwent PET/computed tomography staging scans. SUVmax readings were compared with those of 37 patients with solid NSCLC tumours but with similar staging. Maximum tumour diameters were recorded together with survival at 2 years.

RESULTS

Mean SUVmax, corrected for body weight, of the cavitated tumours was 14+/-6.8, compared with 13.5+/-10.8 for the solid tumours. No significant difference on paired t-tests was seen (P=0.83). The maximum diameter of the tumour was significantly greater (P<0.05) for the cavitated tumours (5.8+/-2.4 cm) than for solid tumours (4.4+/-2.4 cm). Six patients with cavitated tumours died at 2 years compared with 11 with solid tumours; no significant difference in survival (two-sided P value=0.48, Fisher's exact test) was observed between patients with cavitated tumours and those with solid tumours.

CONCLUSION

These findings do not support cavitation as a separate prognostic feature in NSCLC. Only tumour diameter was increased overall in the cavitated group. No increased glycolysis on PET/computed tomography imaging, relative to solid tumours, was seen and overall survival at 2 years seemed similar between the two groups.

Retrospective evaluation of the clinical and radiographic risk factors associated with severe pulmonary hemorrhage in first-line advanced, unresectable non-small-cell lung cancer treated with Carboplatin and Paclitaxel plus bevacizumab

PURPOSE

Severe (grade >or= 3) pulmonary hemorrhage (PH) in advanced non-small-cell lung cancer was observed in two prospective, randomized, phase II (N = 99) and phase III (N = 878) trials of bevacizumab plus carboplatin and paclitaxel. Retrospective case-control and cohort analyses were conducted to identify associated radiographic and clinical risk factors for PH.

PATIENTS AND METHODS

Six patients with PH from the phase II trial, 15 potential PH patients with hemorrhage at any site from the phase III trial, and their matched controls were evaluated with review of baseline and on-treatment radiographs by an independent radiology facility, blinded to patient/control status. Patients with severe (grade >or= 3) PH from each trial were matched with up to three controls based on sex, age group, histology (phase II), or sex and age group (phase III).

RESULTS

Seven PH patients in the phase III trial were identified as severe PH. Six of the patients were early onset (occurred < 150 days of initiating bevacizumab) and one was late onset. Baseline tumor cavitation, not tumor location, was identified as the only potential risk factor for patients with early onset. Combined analysis of severe PH patients from the phase II and phase III trials (n = 13), compared with their pooled matched controls (n = 42), did not identify any additional baseline radiographic or clinical variables associated with PH.

CONCLUSION

PH was an uncommon event. Based on these analyses, baseline tumor cavitation may be a potential risk factor for PH. No other baseline clinical variables were predictive for PH although the number of events was small.

Hypercalcemia-leukocytosis syndrome in a patient with cavitating squamous cell carcinoma of the lung

Introduction

Lung cancer is the leading cause of death among the cancers seen in the United States. Hypercalcemia and leukocytosis are two common paraneoplastic syndromes associated with lung cancer. Unfortunately patients presenting with Hypercalcemia- leukocytosis syndrome has a worse prognosis than patients presenting with lung cancer alone.

Case presentation

We present a 67 yr old Caucasian male with a history of active smoking presenting as pneumonia being diagnosed as cavitating squamous cell carcinoma of the lung with hypercalcemia-leukocytosis syndrome

Conclusion

There should be a high degree of suspicion to diagnose lung cancer in patients presenting with symptoms of paraneoplastic syndrome.

Elderly patients with squamous lung carcinoma: faring better or worse?

INTRODUCTION

Nonsmall cell lung cancer is increasingly diagnosed at an advanced age and squamous cell carcinoma is the commonest histological type encountered in older patients. The clinical course, management, and outcome of squamous lung cancer in the elderly have not been thoroughly studied to date.

PATIENTS AND METHODS

We retrospectively analyzed 236 squamous cell lung cancer patients diagnosed in two reference hospitals and compared key epidemiological, clinical, and management features between elderly (>70 years) and younger patients. Sixty-four were aged more than 70 years at diagnosis while 172 were up to 70 years of age.

RESULTS

There were no differences between the two groups in gender or stage distribution. No differences were observed in the nature or duration of presenting symptoms, the appearance of pleurisy, atelectasis or vascular invasion, the incidence of distant metastatic spread, or the response to combination chemotherapy. Elderly patients were less fit (performance status 2/3 30 vs 20%, p=0.03), developed hemoptysis more often (56 vs 42%, p=0.04), and presented with smaller tumor primaries (median 4 vs 8 cm, p=0.004). When metastases were present, older patients exhibited a tropism for bony (64 vs 29%, p=0.03) and rarity of brain (5 vs 14%, p=0.03) deposits. Though elderly subjects received chemotherapy (63 vs 82%, p=0.003) or radiotherapy (29 vs 48%, p=0.009) less often than their younger counterparts, they tolerated it well and achieved comparable median time to treatment failure and overall survival (median 17 vs 18 months, log-rank p=0.22). Platinum-based chemotherapy and potentially curative management were applied less often in older patients.

CONCLUSIONS

Older patients are less fit, develop bony but not brain metastases, receive antineoplastic treatment less often, and survive as long as younger patients. Squamous lung carcinoma may follow a more indolent clinical course in the elderly, a hypothesis worth validating by case-cohort studies and molecular profiling, with the hope to rationally individualize patient treatment.