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Hassan M, Ehle B, Passlick B, Grapatsas K. Lung Resections for Elderly Patients with Lung Metastases: A Comparative Study of the Postoperative Complications and Overall Survival. Curr Oncol 2022; 29:4511-4521. [PMID: 35877217 PMCID: PMC9323760 DOI: 10.3390/curroncol29070357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/16/2022] [Accepted: 06/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Pulmonary metastasectomy (PM) is an established treatment option for selected patients with stage IV solid tumors. The aim of this study was to investigate the feasibility of and survival rate in PM for elderly patients. Methods: We retrospectively analyzed all of the patients who underwent PM with curative intention at our institution. The patients were categorized into two groups: the elderly group (≥70 years old) and the non-elderly group (<70 years old). Results: The elderly group consisted of 222 patients versus 538 patients in the non-elderly group. The median number of resected metastases was 2 ± 3 in the elderly group and 4 ± 5 in the non-elderly group (p < 0.01). No difference in the rate of postoperative complications was observed between the two groups (p = 0.3). The median length of hospital stay in each group was comparable (10 ± 5 vs. 10 ± 4.3 days, p = 0.3). The 5-year survival rate was 67% in the elderly group and 78% in the non-elderly group (p = 0.117). In the univariate analysis, COPD was associated with poor survival in the elderly group (p = 0.002). Conclusion: The resection of pulmonary metastases in elderly patients is safe, is not associated with increased risks of postoperative complication, and the survival benefit is not reduced in selected patients.
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Affiliation(s)
- Mohamed Hassan
- Department of Thoracic Surgery, Medical Center-University of Freiburg, 79106 Freiburg im Breisgau, Germany; (B.E.); (B.P.); (K.G.)
- Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany
- Correspondence: ; Tel.: +49-7610-270-90700
| | - Benjamin Ehle
- Department of Thoracic Surgery, Medical Center-University of Freiburg, 79106 Freiburg im Breisgau, Germany; (B.E.); (B.P.); (K.G.)
- Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, Medical Center-University of Freiburg, 79106 Freiburg im Breisgau, Germany; (B.E.); (B.P.); (K.G.)
- Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany
| | - Konstantinos Grapatsas
- Department of Thoracic Surgery, Medical Center-University of Freiburg, 79106 Freiburg im Breisgau, Germany; (B.E.); (B.P.); (K.G.)
- Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany
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Watanabe K, Katsui K, Sugiyama S, Yoshio K, Kuroda M, Hiraki T, Kiura K, Maeda Y, Toyooka S, Kanazawa S. Lung stereotactic body radiation therapy for elderly patients aged ≥ 80 years with pathologically proven early-stage non-small cell lung cancer: a retrospective cohort study. Radiat Oncol 2021; 16:39. [PMID: 33622369 PMCID: PMC7903684 DOI: 10.1186/s13014-021-01769-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/11/2021] [Indexed: 12/25/2022] Open
Abstract
Background Stereotactic body radiation therapy (SBRT) is an established therapy for medically inoperable early-stage non-small cell lung cancer (NSCLC). Many elderly patients are medically inoperable owing to comorbidities. Therefore, SBRT may be a useful therapy for elderly patients. However, the application of SBRT for patients aged ≥ 80 years has not been completely elucidated. Therefore, this study aimed to assess the clinical utility of SBRT for elderly patients aged ≥ 80 years with pathologically proven early-stage NSCLC. Methods We retrospectively evaluated the data of patients aged ≥ 80 years with pathologically proven primary NSCLC who underwent SBRT at our institution between January 2009 and March 2020. Treatment outcomes and toxicities were analyzed. We used the Kaplan–Meier method to estimate survival curves and the log-rank test to compare the survival curves. We performed univariate and multivariate Cox regression analyses. p-values < 0.05 were regarded significant. Results Sixty-four patients (65 lesions) were included, and the median follow-up period was 38.7 (range 3.5–95.7) months. The median age was 82.9 (range 80.0–94.8) years. Sixteen patients were medically operable, and 48 patients were medically inoperable. The prescribed dose of SBRT was either 48 Gy in four fractions or 60 Gy in 10 fractions. The median survival time was 60.0 months (95% confidence interval, 43.5–71.1). The 1-, 3-, and 5-year local control, cancer-specific survival, progression-free survival, and overall survival rates were 98.4%, 98.4%, 81.0%, and 88.9%; 90.1%, 93.7%, 58.9%, and 68.3%; and 87.4%, 83.5%, 38.2%, and 47.5%, respectively. Multivariate analysis revealed that inoperability and solid nodules were the predictors of poor overall survival after SBRT in elderly patients. Two patients (3.1%) had grade 3 radiation pneumonitis, and one patient (1.6%) had grade 5 radiation pneumonitis. Conclusions SBRT was feasible in patients aged ≥ 80 years with NSCLC. It achieved good local control with minimal toxicity. SBRT may be beneficial in elderly patients with early-stage NSCLC.
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Affiliation(s)
- Kenta Watanabe
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Kuniaki Katsui
- Department of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Soichiro Sugiyama
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Kotaro Yoshio
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Masahiro Kuroda
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Takao Hiraki
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Katsuyuki Kiura
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yoshinobu Maeda
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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3
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Bei Y, Murakami N, Nakayama Y, Okuma K, Kashihara T, Raturi VP, Okamoto H, Takahashi K, Inaba K, Igaki H, Itami J. Stereotactic body radiation therapy for early-stage non-small-cell lung cancer in octogenarians and older: an alternative treatment. JOURNAL OF RADIATION RESEARCH 2020; 61:586-593. [PMID: 32383730 PMCID: PMC7336556 DOI: 10.1093/jrr/rraa027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/15/2020] [Accepted: 04/07/2020] [Indexed: 06/11/2023]
Abstract
Surgery is the standard modality for early-stage I-II non-small-cell lung cancer (NSCLC). Generally, patients who are >80 years old tend to have more comorbidities and inferior physical status than younger patients. Stereotactic body radiation therapy (SBRT) may provide an alternative treatment for this group of patients. Here, we report our experience using SBRT to in the management of early-stage NSCLC in patients >80 years old. Patients aged ≥80 years old who were diagnosed with early-stage NSCLC and treated with definitive lung SBRT from January 2000 to January 2018 were retrospectively analysed. Local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), cancer-specific survival (CSS), progression-free survival (PFS), overall survival (OS) and treatment-related toxicities were analysed for patients >80 years old. A total of 153 patients were included, with a median age of 85 years (range, 80-94). The median follow-up period and OS was 39.8 months (range, 10-101 months) and 76 months, respectively. The 3-year OS, PFS, CSS, RRFS and LRFS were 65.3, 58.0, 75.7, 73.9 and 85.3%, respectively. Radiation pneumonitis grade 0-1, grade 2, grade 3 and grade 4 was observed in 135 (88.2%), 13 (8.5%), 4 (2.61%) and 1 (0.6%) patient(s), respectively. On multivariate analyses, tumor size, pretreatment C-reactive protein (CRP) value, histology and pretreatment physical state were significantly associated with OS. Definitive lung SBRT appears to have high LRFS and OS without causing high-grade radiation-related toxicities in early-stage NSCLC patients who were >80 years old.
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Affiliation(s)
- Yanping Bei
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
- Department of Radiation Oncology, Ningbo Medical Treatment Center, Lihuili Hospital, China
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Nakayama
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kae Okuma
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tairo Kashihara
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Vijay Parshuram Raturi
- Department of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hiroyuki Okamoto
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kana Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Koji Inaba
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
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A retrospective review of patients over 70 years of age undergoing pneumonectomy for non-small cell lung cancer: 10 years of experience, a cross-sectional study. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.727381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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5
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Sun L, Dai J, Wang X, Jiang G, Gonzalez-Rivas D, Song J, Zhang P. Pulmonary carcinosarcoma: analysis from the Surveillance, Epidemiology and End Results database. Interact Cardiovasc Thorac Surg 2019; 30:4-10. [PMID: 31518405 DOI: 10.1093/icvts/ivz215] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/05/2019] [Accepted: 08/11/2019] [Indexed: 12/25/2022] Open
Abstract
AbstractOBJECTIVESPulmonary carcinosarcoma (PCS) is a rare neoplasm. This study explored the clinicopathological characteristics and survival outcomes of PCS.METHODSThe Surveillance, Epidemiology and End Results (SEER) database (1988–2014) was queried for PCS. Overall survival (OS) was evaluated by multivariable Cox regression and nomograms were constructed to predict 3-year OS for PCS. Prognostic performance was evaluated using concordance index and area under the curve analysis. In M0 surgically treated patients, interaction assessments were performed using likelihood ratio tests. Subgroup analysis was performed according to patient age. The clinical features of PCSs were further compared to other non-small-cell lung cancers (NSCLCs).RESULTSMultivariable analysis identified age [hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.01–1.04], surgery (HR 0.53, 95% CI 0.36–0.77) and chemotherapy (HR 0.51, 95% CI 0.36–0.73) as significantly associated with OS. The nomogram had a concordance index of 0.747 and an area under the curve of 0.803. The association between age and OS was stronger in those receiving pneumonectomy (P = 0.04 for interactions) compared to those that did not (HR 5.14, 95% CI 1.64–16.07), and was associated with a poorer outcome compared to lobectomy amongst the elderly (age ≥ 70 years). Patients with PCS were more likely to receive surgical treatment and had lower lymphatic metastasis compared to adenocarcinoma, squamous cell carcinoma and large cell carcinoma (all P < 0.05).CONCLUSIONSPCS had unique clinical features compared to common types of NSCLCs in terms of lymphatic invasion and surgical treatment. Pneumonectomy was associated with poorer survival in elderly patients.
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Affiliation(s)
- Liangdong Sun
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xujun Wang
- Department of SJTU-Yale Joint Center for Biostatistics, School of Life Science and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
| | - Jiong Song
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Peng Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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Briend G, Planquette B, Badia A, Vial A, Laccourreye O, Le Pimpec-Barthes F, Meyer G, Sanchez O. Impact of previous head and neck cancer on postoperative complications after surgical resection for lung cancer: a case-control study. J Thorac Dis 2018; 10:3948-3956. [PMID: 30174836 DOI: 10.21037/jtd.2018.06.77] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Head and neck cancer (HNC) and lung cancer are often linked because of common risk factors. We aimed to assess the risk of postoperative complications in patients with previous HNC undergoing thoracic surgery for lung cancer. Methods Patients with previous HNC undergoing surgery for lung cancer were included in this retrospective, monocentric, case-control study. All patients were matched for age, sex, FEV1, smoking history, and year of surgery with lung cancer patients without previous HNC. Major postoperative complication was defined as at least one of the following during the first 30 days post lung resection (LR): death, shock, need for mechanical ventilation, and pneumonia. Results From January 2006 to May 2012, 65 patients with previous HNC underwent LR. Fifty-nine of these patients were included and matched with 120 control patients without HNC. Major complications occurred in 25 [42.4% (95% CI, 29.4-55.4%)] vs. 19 [15.8% (95% CI, 9.2-22.5%)] patients in the HNC and non-HNC groups, respectively (P<0.001). Among the complications, pneumonia occurred in 19 (32.2%) vs. 12 (10%) (P=0.01), and death occurred in 5 (8.5%) vs. 2 (1.7%) patients in the HNC and non-HNC groups, respectively (P=0.04). The following factors were identified by multivariate analysis to be independently associated with postoperative complications: previous HNC [odds ratio (OR) =4.24; (95% CI, 1.84-9.74)], male gender [OR =8.99; (95% CI, 1.05-76.78)], cumulative smoking [OR =1.02 per unit; (95% CI, 1.01-1.04)] and elevated Charlson score [OR =1.45; (95% CI, 1.07-1.96)]. Conclusions Previous HNC is a major independent risk factor for serious postoperative complications after LR for lung cancer. Postoperative pneumonia (POP) is the most frequent complication.
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Affiliation(s)
- Guillaume Briend
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Service de Pneumologie et Soins Intensifs, HEGP, AP-HP, Paris, France
| | - Benjamin Planquette
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Service de Pneumologie et Soins Intensifs, HEGP, AP-HP, Paris, France
| | - Alain Badia
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Service de Chirurgie Thoracique et Transplantation Pulmonaire, HEGP, AP-HP, Paris, France
| | - Amandine Vial
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Service de Pneumologie et Soins Intensifs, HEGP, AP-HP, Paris, France
| | - Ollivier Laccourreye
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Service d'Otho-Rhino-Laryngologie, HEGP, AP-HP, Paris, France
| | - Françoise Le Pimpec-Barthes
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Service de Chirurgie Thoracique et Transplantation Pulmonaire, HEGP, AP-HP, Paris, France
| | - Guy Meyer
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Service de Pneumologie et Soins Intensifs, HEGP, AP-HP, Paris, France
| | - Olivier Sanchez
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Service de Pneumologie et Soins Intensifs, HEGP, AP-HP, Paris, France
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Spaggiari L, Petrella F, Maione P, Gridelli C. Lung cancer resection in octogenarian patients. J Thorac Dis 2018; 10:S1995-S1997. [PMID: 30023101 DOI: 10.21037/jtd.2018.05.39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lorenzo Spaggiari
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Francesco Petrella
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Paolo Maione
- Division of Medical Oncology, 'S. G. Moscati' Hospital, Avellino, Italy
| | - Cesare Gridelli
- Division of Medical Oncology, 'S. G. Moscati' Hospital, Avellino, Italy
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8
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A nomogram to predict prognosis after surgery in early stage non-small cell lung cancer in elderly patients. Int J Surg 2017; 42:11-16. [DOI: 10.1016/j.ijsu.2017.04.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 04/04/2017] [Accepted: 04/12/2017] [Indexed: 11/21/2022]
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9
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Prediction of Surgical Outcome by Modeling Based on Risk Factors of Morbidity After Pulmonary Resection for Lung Cancer in Older Adults. Ann Thorac Surg 2016; 102:971-978. [PMID: 27283110 DOI: 10.1016/j.athoracsur.2016.03.116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/26/2016] [Accepted: 03/30/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Surgical treatment for older patients with lung cancer presents more challenges compared with general population. The aim of the study was to predict surgical outcome after pulmonary resection in older patients with lung cancer by developing a clinical model. METHODS Clinical records of 525 patients who were older than 70 years of age and who underwent pulmonary resection for lung cancer in a single center were reviewed. Patients were divided into three ordered categories of surgical outcome according to the Clavien-Dindo classification. By using a development cohort of 401 patients, an ordinal logistic regression was performed to develop a prediction model for surgical outcome. The model was internally validated by the bootstrap method and was externally validated by another cohort of 124 patients. Two previous models were tested as benchmarks of our model. RESULTS The model was developed based on five risk factors of morbidity: American Society of Anesthesiologists classification (p < 0.001), pulmonary disease (p = 0.001), tumor size (p = 0.011), tumor location (p = 0.015), and surgical approach (p = 0.036). The c-statistic of the model was 0.75 (95% confidence interval: 0.69 to 0.80), which was similar to the bootstrapping one (0.75; 95% confidence interval: 0.68 to 0.80). The Hosmer-Lemeshow test showed a strong goodness of fit of the model (p = 0.674). In external validation, the performance of our model was superior to that of the two previous models. CONCLUSIONS Our model displayed an acceptable ability to predict surgical outcome in older patients undergoing pulmonary resection for lung cancer. Use of the model can be helpful in decision making about surgical treatment in this special population.
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Blanco R, Maestu I, de la Torre MG, Cassinello A, Nuñez I. A review of the management of elderly patients with non-small-cell lung cancer. Ann Oncol 2014; 26:451-63. [PMID: 25060421 DOI: 10.1093/annonc/mdu268] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Most patients with non-small-cell lung cancer (NSCLC) are elderly but evidence to guide appropriate treatment decisions for this age group is generally scant. Careful evaluation of the elderly should be undertaken to ensure that treatment appropriate for the stage of the tumour is guided by patient characteristics and not by age. The Comprehensive Geriatric Assessment (CGA) remains the preferred option, but briefer tools may be appropriate to select patients for further evaluation. The predicted outcome should be used to guide management decisions together with a reappraisal of polypharmacy. Patient expectations should also be taken into account. Management recommendations are generally similar to those of general guidelines for the NSCLC population, although the risks of surgery and toxicity of chemotherapy and radiotherapy are often increased in the elderly compared with younger patients; therefore, patients should be closely scrutinised and subjected to a CGA to ensure suitability of the planned treatment. If surgery is indicated, then lobectomy is generally the preferred option, although limited resection may be more feasible for some. Radiotherapy with curative intent is an alternative, with stereotactic body radiotherapy the most likely preferred modality. Adjuvant chemotherapy is also an appropriate approach, whereas adjuvant radiotherapy is generally not recommended. Concurrent chemoradiotherapy should be considered for elderly patients with inoperable locally advanced disease and chemotherapy for advanced/metastatic disease. Efforts should also be made to increase participation of elderly patients with NSCLC in clinical trials, thereby enhancing evidence-based treatment decisions for this majority group. This will require overcoming barriers relating to trial design and to physician and patient awareness and attitudes.
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Affiliation(s)
- R Blanco
- Oncology Service, Consorci Sanitari de Terrassa, Ctra. de Torrebonica sn, Terrassa
| | - I Maestu
- Department of Oncology, Hospital Universitario Dr Peset, Avenida de Gaspar Aguilar, Valencia and
| | | | - A Cassinello
- Medical Department, Lilly Spain, Alcobendas, Spain
| | - I Nuñez
- Medical Department, Lilly Spain, Alcobendas, Spain
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11
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Testori A, Meroni S, Cariboni U, Errico V, Voulaz E, Infante VM, Alloisio M. A very elderly lung cancer patient: case report of a long disease free survival. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:470-3. [PMID: 23801173 DOI: 10.5761/atcs.cr.12.02127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite the fact that non-small-cell lung cancer (NSCLC) is very common in the older population, these patients are frequently underrepresented in clinical and surgical trials and thus it is difficult to reach evidence-based recommendations for this special population. We present a case of a surgical treatment of asymptomatic lung cancer in a very elderly patient. The patient had no recurrence for 4 years after a complete resection.
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Affiliation(s)
- Alberto Testori
- Unità Operativa di Chirurgia Toracica e Generale, Istituto Clinico Humanitas, Milano, Italy
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12
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Takeda A, Sanuki N, Eriguchi T, Kaneko T, Morita S, Handa H, Aoki Y, Oku Y, Kunieda E. Stereotactic Ablative Body Radiation Therapy for Octogenarians With Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2013; 86:257-63. [DOI: 10.1016/j.ijrobp.2013.01.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 12/24/2012] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
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13
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Zhang J, Xue ZQ, Chu XY, Wang YX, Zhao JH, Xu C, Yin LG. Surgical treatment and prognosis of octogenarians with non-small cell lung cancer. ASIAN PAC J TROP MED 2012; 5:465-8. [DOI: 10.1016/s1995-7645(12)60079-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 04/15/2012] [Accepted: 06/15/2012] [Indexed: 11/26/2022] Open
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Pallis AG, Scarci M. Are we treating enough elderly patients with early stage non-small cell lung cancer? Lung Cancer 2011; 74:149-54. [PMID: 21696842 DOI: 10.1016/j.lungcan.2011.05.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 05/24/2011] [Accepted: 05/25/2011] [Indexed: 10/18/2022]
Abstract
Despite the fact that non-small-cell lung cancer (NSCLC) is very common in the older population, these patients are frequently underrepresented in clinical trials evaluating new anti-cancer agents, and thus it is difficult to reach evidence-based recommendations for this special population. The purpose of the present paper is to present the currently available evidence regarding treatment of early-stages of NSCLC in older patients. Although, age is still considered as a negative factor influencing treatment decisions and curative cancer-directed surgery is often omitted in the older population several studies support that surgical resection is feasible in the older patient and that age per se is not a contraindication for various surgical procedures. Pneumonectomy is associated with a higher mortality in the older population and this issue should be taken into account when deciding whether a patient is suitable for pneumonectomy. Older patients should be considered for adjuvant chemotherapy after surgical resection although little information is available regarding the real benefit and tolerability of these regimens for patients over 75 years of age. Given the lack of demonstrated benefit for the use of adjuvant RT it is also not recommended in older population.
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Affiliation(s)
- A G Pallis
- Department of Medical Oncology, University General Hospital of Heraklion, Voutes-Stavrakion Embranchement, 71305 Heraklion, Greece.
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15
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Pallis AG, Gridelli C, van Meerbeeck JP, Greillier L, Wedding U, Lacombe D, Welch J, Belani CP, Aapro M. EORTC Elderly Task Force and Lung Cancer Group and International Society for Geriatric Oncology (SIOG) experts' opinion for the treatment of non-small-cell lung cancer in an elderly population. Ann Oncol 2009; 21:692-706. [PMID: 19717538 DOI: 10.1093/annonc/mdp360] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Non-small-cell lung cancer (NSCLC) represents a common health issue in the elderly population. Nevertheless, the paucity of large, well-conducted prospective trials makes it difficult to provide evidence-based clinical recommendations for these patients. The present paper reviews the currently available evidence regarding treatment of all stages of NSCLC in elderly patients. Surgery remains the standard for early-stage disease, though pneumonectomy is associated with higher incidence of postoperative mortality in elderly patients. Given the lack of demonstrated benefit for the use of adjuvant radiotherapy, it is also not recommended in elderly patients. Elderly patients seem to derive the same benefit from adjuvant chemotherapy as younger patients do, with no significant increase in toxicity. For locally advanced NSCLC, concurrent chemoradiotherapy may be offered to selected elderly patients as there is a higher risk for toxicity reported in the elderly population. Third-generation single-agent treatment is considered the standard of care for patients with advanced/metastatic disease. Platinum-based combination chemotherapy needs to be evaluated in prospective trials. Unfortunately, with the exception of advanced/metastatic NSCLC, prospective elderly-specific NSCLC trials are lacking and the majority of recommendations made are based on retrospective data, which might suffer from selection bias. Prospective elderly-specific trials are needed.
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Affiliation(s)
- A G Pallis
- EORTC Headquarters, EORTC-ETF, Brussels, Belgium.
| | - C Gridelli
- Division of Medical Oncology, "S.G. Moscati" Hospital, Avellino, Italy
| | - J P van Meerbeeck
- Department of Respiratory Medicine & Thoracic Oncology, Ghent University Hospital, Gent, Belgium; EORTC Lung Cancer Group, Brussels, Belgium
| | - L Greillier
- EORTC Lung Cancer Group, Brussels, Belgium; Department of Thoracic Oncology, Assistance Publique-Hôpitaux de Marseille, Faculté de Médecine, Université de la Méditerranée, Marseille, France
| | - U Wedding
- Department of Hematology, Oncology, Palliative Care, University Hospital Jena, Jena, Germany
| | - D Lacombe
- EORTC Headquarters, EORTC-ETF, Brussels, Belgium
| | - J Welch
- EORTC Headquarters, EORTC Lung Cancer Group, Brussels, Belgium
| | - C P Belani
- Department of Medicine, Penn State Cancer Hershey Institute, Hershey, USA
| | - M Aapro
- IMO Clinique de Genolier, Genolier, Switzerland
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Browner I, Purtell M. Chemotherapy in the Older Patient with Operable Non–Small Cell Lung Cancer: Neoadjuvant and Adjuvant Regimens. Thorac Surg Clin 2009; 19:377-89. [DOI: 10.1016/j.thorsurg.2009.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
PURPOSE OF REVIEW Pneumonectomy has the highest perioperative risk among common pulmonary resections. The purpose of this review is to update clinicians on the importance of anesthetic management for these patients. RECENT FINDINGS Two complications associated with increased perioperative mortality are relevant to anesthetic management: postoperative arrhythmias and acute lung injury. The geriatric population is particularly at risk for arrhythmias. Adequate preoperative cardiac assessment and drug prophylaxis may decrease this risk. Patients with decreased respiratory function are at increased risk for acute lung injury. The use of large tidal-volume ventilation during anesthesia may increase this risk. There is a trend to better outcomes in centers with larger surgical volumes. SUMMARY Patients should have a preoperative assessment of their respiratory function in three areas: lung mechanical function, pulmonary parenchymal function and cardiopulmonary reserve. Interventions that have been shown to decrease the incidence of respiratory complications include cessation of smoking, physiotherapy and thoracic epidural analgesia. Extrapleural pneumonectomy and sleeve pneumonectomy are surgical variations that place specific increased demands on the anesthesiologist. The rare but treatable complication of cardiac herniation must always be remembered as a potential cause of life-threatening hemodynamic instability in the early postoperative period.
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The Influence of Preoperative Risk Stratification on Fast-Tracking Patients After Pulmonary Resection. Thorac Surg Clin 2008; 18:113-8. [DOI: 10.1016/j.thorsurg.2007.10.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Kim HS, Hyun DS, Kim KC, Lee SC, Jung TH, Park JY, Kim CH, Cha SI, Lee KH, Chung JH, Shin KC, Jeon YJ, Han SB, Choi WI, Kim YJ, Chung CY, Lim GI. The Clinical Characteristics and Prognosis of Elderly Patients with Lung Cancer Diagnosed in Daegu and Gyeongsangbukdo. Tuberc Respir Dis (Seoul) 2008. [DOI: 10.4046/trd.2008.65.1.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hyun Sook Kim
- Department of Internal Medicine, College of Medicine, Catholic University of Daegu, Korea
| | - Dae Sung Hyun
- Department of Internal Medicine, College of Medicine, Catholic University of Daegu, Korea
| | - Kyung Chan Kim
- Department of Internal Medicine, College of Medicine, Catholic University of Daegu, Korea
| | - Sang Chae Lee
- Department of Internal Medicine, College of Medicine, Catholic University of Daegu, Korea
| | - Tae Hoon Jung
- Department of Internal Medicine, College of Medicine, Kyungpook National University, Korea
| | - Jae Yong Park
- Department of Internal Medicine, College of Medicine, Kyungpook National University, Korea
| | - Chang Ho Kim
- Department of Internal Medicine, College of Medicine, Kyungpook National University, Korea
| | - Seung Ick Cha
- Department of Internal Medicine, College of Medicine, Kyungpook National University, Korea
| | - Kwan Ho Lee
- Department of Internal Medicine, College of Medicine, Yeungnam University, Korea
| | - Jin Hong Chung
- Department of Internal Medicine, College of Medicine, Yeungnam University, Korea
| | - Kyeong Cheol Shin
- Department of Internal Medicine, College of Medicine, Yeungnam University, Korea
| | - Young June Jeon
- Department of Internal Medicine, College of Medicine, Keimyung University, Korea
| | - Seong Beom Han
- Department of Internal Medicine, College of Medicine, Keimyung University, Korea
| | - Won Il Choi
- Department of Internal Medicine, College of Medicine, Keimyung University, Korea
| | - Yeun Jae Kim
- Department of Internal Medicine, Daegu Fatima Hospital, Korea
| | - Chi Young Chung
- Department of Internal Medicine, Daegu Fatima Hospital, Korea
| | - Geon Il Lim
- Department of Internal Medicine, College of Medicine, Soonchunhyang University, Gumi, Korea
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