[Abstract] Objective radiochemical analysis of 70 years of age or older with locally advanced non-small cell lung cancer therapy, and to explore the feasibility of comprehensive treatment. Analysis of 61 patients 70 years and older with locally advanced non-small cell lung cancer treatment to the same period 75 patients <70 years of age with locally advanced non-small cell lung cancer as controls. Results ≥ 70 age group, the median survival time of 18 months, the 1 -, 3 -, and 5-year survival rates were 78.15%, 18.47%, 10.39%; <70-year-old group, the median survival time was 19 months, 1,3 The 5-year survival rates were 69.44%, 18.27%, 8.08%, no statistically significant difference in survival in the two groups. In addition to the obvious ≥ 70 years of age myelosuppression and other side effects was no significant difference between the two groups. Conclusion the treatment of elderly patients with locally advanced non-small cell lung cancer is no unified program, appropriate given comprehensive treatment is feasible.

Words non-small cell lung radiotherapy chemotherapy elderly

    With the global aging issues have become increasingly prominent, elderly lung cancer incidence and mortality rates are gradually rising. The report from the U.S. National database: lung cancer patients over the age of 70 accounted for 43%, including 80% of non-small cell lung cancer [1]. Advanced lung cancer accounted for most. However, numerous studies in the elderly are often excluded, so far there is no best treatment options for this group. Our department from January 2000 to December 2004, 61 patients were treated 70 years of age or older with locally advanced non-small cell lung cancer in the same period in the treatment of 75 patients <70 years of age with locally advanced non-small cell lung cancer as control, in order to explore the feasibility of comprehensive treatment.

    1 Materials and Methods

    1.1 General Information

    61 patients aged ≥ 70 patients, aged 70 to 85 years old, with a median age of 74 years; 75 cases of 70-year-old patients, aged 39 to 69 years old, with a median age of 57 years old. According to the UICC lung cancer staging, are inoperable locally advanced non-small cell lung cancer. The two sets of data are shown in Table 1. Patients gender, age, stage, pathology, ratings, chemotherapy, radiotherapy constitutes difference was not statistically significant.

    1.2 Treatment

    The two groups of patients was treated with radiotherapy and radiotherapy followed by chemotherapy.

    1.2.1 chemotherapy chemotherapy with platinum-based combination chemotherapy. ≥ 70 age group in the DDP + VP  16 by 15 cases, DDP + NVP were 25 cases, DDP + TXT those 21 cases. Sequential radiotherapy and chemotherapy in 41 cases, concurrent chemoradiotherapy 20 cases. <70 age group in the DDP + VP  16 by 20 cases, the DDP + NVP 35 cases, DDP + TXT those 20 cases, the use of sequential radiotherapy and chemotherapy in 33 cases, 42 cases of concurrent chemoradiotherapy. Two groups is shown in table 1.

    1.2.2 radiotherapy using a linear accelerator external irradiation 6MV/10MV X line, set the wild range including the primary tumor, ipsilateral hilar and mediastinal lymph drainage area, such as supraclavicular lymph node metastasis separate wild. 1.8 ~ 2Gy / (· day), five times / week previously after wild with irradiation doses up to 40Gy change oblique wild avoiding the spinal cord irradiation, the total radiation dose of 60 to 64Gy, the two groups were not the lung correction. Is shown in table 1. Table 1 two groups of patients clinical data

    1.3 statistical methods

    Comparison of clinical data and toxicity χ2 test was used to compare survival analysis using KaplanMeier law, Logrank Inspection difference in survival. The survival time from the start of chemotherapy or radiotherapy.

    1.4 Evaluation Criteria

    Chemotherapy adverse WHO unified standard assessment, radiotherapy toxicity by RTOG criteria evaluation.

    2 Results

    2.1 Follow-up

    Last follow-up time for the July 31, 2007, nine cases were lost to follow-up rate was 93.4%.

    2.2 survival

    ≥ 70 years of age group, the median survival time was 18 months, the 1 -, 3 -, and 5-year survival rates were 78.15%, 18.47%, 10.39%; <70 age group, the median survival time was 19 months, 1,3,5 year survival rates were 69.44%, 18.27%, 8.08%. (Logrank test χ2 = 0.31, P = 0.5774). The survival curves of groups shown in Figure 1.

    2.3 toxicity

    Gastrointestinal tract and bone marrow suppression, liver and kidney toxicity, esophagitis and radiation-induced lung injury is the most common side effects in radiotherapy and after radiotherapy, chemotherapy during or after chemotherapy. The major toxicities of the two groups of patients were statistically only three and four bone marrow suppression were significantly different (χ 2 = 14, P <0.001), respectively (χ2 = 4.46, P <0.05). But there is no occurrence of chemotherapy-related death. Patients with ≥ 70 years of age group 1 patients due to acute radiation pneumonitis leading to respiratory failure and death, are shown in Table 2. Table 2 two groups of patients with major toxicity data comparison

    3 Discussion

    Elderly patients with non-small cell lung cancer patients due to various organs of the body function decline, more complications, poor chemoradiotherapy tolerated. Therefore, many problems need to be considered for the treatment of these patients. Rocha Lima CM assess of the CALGB the two test result ≥ 70 years of age with locally advanced or advanced non-small cell lung cancer patients with radiotherapy and chemotherapy tolerance, efficiency, survival and <70 years of age were no significant differences. Hematologic toxicity (leukopenia) a significant increase in the elderly patients, but no serious infections. Conclusion: advanced non-small cell lung cancer patients over the age of 70 should not give up aggressive treatment [2]. Domestic Ou Guangyuan fly [3] pointed out that age has no effect on overall survival analysis of 289 patients with locally advanced non-small cell lung cancer treatment results. The results of this paper also suggest: after chemoradiotherapy positive, locally advanced non-small cell lung cancer patients over the age of 70 have a similar survival rates in patients <70 years of age.

    Locally advanced non-small cell lung cancer patients over the age of 70 to take the kind of treatment program is the most appropriate, and there are a lot of controversy. The Luo Yang reported that elderly patients ≥ 70 years of age tolerability of chemotherapy, chemotherapy increased risk [4]. Yeung Chi Hung et al [5] reported radiotherapy alone and put the results of chemotherapy in the comprehensive treatment of elderly patients with non-small cell lung cancer, and 2-year survival rate of both the difference was not statistically significant, but the combined therapy group gastrointestinal reactions, bone marrow suppression were than radiotherapy alone group, the difference was statistically significant. Tombolini [6] ≥ 70 years of age with locally advanced non-small cell lung cancer patients treated with radiotherapy alone method, to get a better 2-year survival and disease-free survival, and is therefore recommended for elderly non-surgical patients to choose radiotherapy alone. But not enough evidence to prove that elderly patients with chemotherapy useless. On the contrary, with the 3rd generation of the application of chemotherapy drugs, many clinical studies show that elderly patients with locally advanced non-small cell lung cancer patients with chemotherapy prolongs survival time. Standard chemotherapy with platinum-based combination chemotherapy in non-small cell lung cancer, but restricted it in elderly patients due to the platinum such as kidney toxicity. The ECOG study results in general good use of platinum in elderly patients is safe and effective [7]. In this paper, 61 cases of patients ≥ 70 years of age in 54 patients receiving platinum-containing combination chemotherapy, in addition to bone marrow suppression obvious, other side effects in patients <70 years of age showed no significant difference.

    Current trends in the treatment of locally advanced non-small cell lung cancer is synchronous chemoradiotherapy [8], concurrent chemoradiotherapy toxicity than sequential chemoradiotherapy large, may be greater risk for elderly patients. The RTOG a randomized study, non-small cell lung cancer patients ≥ 70 years of age, there are also similar to the separate radiotherapy group, the highest quality of life, can not be extended MST concurrent chemoradiotherapy [9]; Schild SE [10] randomized study results. However, these studies of chemotherapy non 3rd generation of chemotherapy drugs. Therefore, although the radiochemical comprehensive treatment is the main mode of treatment for locally advanced non-small cell lung cancer, in particular, concurrent chemoradiotherapy has more advantages, but in view of the characteristics of elderly patients, it is recommended that the asynchronous mode of treatment is appropriate radiochemical. Schild SE, et al [10] for appropriate elderly patients with locally advanced non-small cell lung cancer patients are also encouraged to adopt a comprehensive treatment of radiotherapy and chemotherapy under careful clinical observation.

    Chemoradiation side effects elderly dysfunction appears compensatory ability is poor, and some may cause serious complications and even life-threatening, this article ≥ 70 years of age group 1 cases of acute radiation pneumonitis leading to respiratory failure and death. Therefore, in the aggressive treatment of elderly patients to be especially cautious.

    There are many cases of lung cancer in elderly concomitant diseases and physiological particularity, many experts advocate individualized treatment. Proposed radiochemical comprehensive treatment for patients with locally advanced non-small cell lung cancer. General, patients with no obvious contraindications can choose platinum-containing combination chemotherapy; elderly patients can not tolerate platinum-based combination chemotherapy, can consider a third-generation chemotherapy drugs single-drug therapy combined with radiotherapy mode. The Yang Qiumin reported that single-agent vinorelbine + radiotherapy treatment of elderly patients with locally advanced / advanced non-small cell lung cancer patients, the results compare with the combined group, the efficacy and quality of life of the single-agent vinorelbine plus radiotherapy group were significantly improved [11] . In addition in recent years the rise of targeted therapies, may become a new research direction for elderly patients with locally advanced non-small cell lung cancer treatment.