The outcome of combined-modality therapy for stage III non-small-cell lung cancer in the elderly
The outcome of combined-modality therapy for stage III non-small-cell lung cancer in the elderly
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DOI：
10.1200/jco.2003.12.019
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发表时间：
2003-09-01
影响因子：
45.3
通讯作者：
Jett, JR
中科院分区：
文献类型：
--
作者：
Schild, SE;Stella, PJ;Jett, JR
(P) 下栏(u) 下栏(r) 下栏(p) 下栏(o) 下栏(s) 下栏(e) 下栏：北中心癌症治疗组进行了一项 III 期试验，以确定化疗加每日一次放射治疗 (RT) 或每日 (qd) RT 是否能为 III 期非小细胞肺癌 (NSCLC) 患者带来更好的结果。两组之间的生存率没有差异。进行二次分析是为了检查患者年龄和结果之间的关系。(P)下栏(a)下栏(t)下栏(i)下栏(e)下栏(n)下栏(t)下栏下(a)下栏(n)下栏(d)下栏(M)下栏(e)下栏(t)下栏(h)下栏(o)下栏(d)下栏下栏下:246名患者被随机分配到接受依托泊苷加顺铂和每日一次 RT 或分疗程 RT bid。这项回顾性研究比较了年龄大于或等于 70 岁的患者（“老年患者”）与年轻人的结果。在 244 名可评估患者中，63 名 (26%) 为老年人，181 名 (74%) 为年轻人。(R) 下栏(e) 下栏(u) 下栏(l) 下栏(t) 下栏(s) 下栏：70 岁以下患者的 2 年和 5 年生存率分别为 39% 和 18%，而 70 岁以下患者的 2 年和 5 年生存率分别为 36% 和 13%，分别在老年患者中 (P = .4)。 70 岁以下患者中 62% 发生 4+ 级毒性，而老年患者中这一比例为 81% (P = .007)。 70 岁以下患者中 56% 发生 4+ 级血液学毒性，而老年患者中这一比例为 78% (P = .003)。 70 岁以下患者中 1% 发生 4+ 级肺炎，而老年患者为 6% (P = .02)。(C) under bar(o) under bar(n) under bar(c) under bar(l) under bar(u) under bar(s) under bar(i) under bar(o) under bar(n) under bar: 毒性，尤其是骨髓抑制和肺炎，在接受治疗的老年患者中更为明显局部晚期 NSCLC 的联合治疗。尽管毒性增加，老年患者的存活率与年轻人相当。因此，应鼓励身体健康的老年局部晚期 NSCLC 患者接受联合治疗，最好是在临床试验中进行谨慎、明智的监测。未来的研究应该探索降低老年患者治疗毒性的方法。 (C) 2003 年，美国临床肿瘤学会。
(P) under bar(u) under bar(r) under bar(p) under bar(o) under bar(s) under bar(e) under bar: The North Central Cancer Treatment Group performed a phase III trial to determine whether chemotherapy plus either bid radiation therapy (RT) or daily (qd) RT resulted in a better outcome for patients with stage III non-small-cell lung cancer (NSCLC). No difference in survival was identified between the two arms. This secondary analysis was performed to examine the relationship between patient age and outcome.(P) under bar(a) under bar(t) under bar(i) under bar(e) under bar(n) under bar(t) under bar(s) under bar (a) under bar(n) under bar(d) under bar (M) under bar(e) under bar(t) under bar(h) under bar(o) under bar(d) under bar(s) under bar: Two hundred forty-six patients were randomized to receive etoposide plus cisplatin and either RT qd or split-course RT bid. This retrospective study compared the outcomes of patients aged greater than or equal to70 years ("elderly patients") with those of younger individuals. Of the 244 assessable patients, 63 (26%) were elderly, and 181 (74%) were younger individuals.(R) under bar(e) under bar(s) under bar(u) under bar(l) under bar(t) under bar(s) under bar: The 2-year and 5-year survival rates were 39% and 18%, respectively, in patients younger than 70 years, compared with 36% and 13%, respectively, in elderly patients (P = .4). Grade 4+ toxicity occurred in 62% of patients younger than 70 years compared with 81% of elderly patients (P = .007). Grade 4+ hematologic toxicity occurred in 56% of patients younger than 70 years, compared with 78% of elderly patients (P = .003). Grade 4+ pneumonitis occurred in 1% of those younger than 70 years, compared with 6% of elderly patients (P = .02).(C) under bar(o) under bar(n) under bar(c) under bar(l) under bar(u) under bar(s) under bar(i) under bar(o) under bar(n) under bar: Toxicity, especially myelosuppression and pneumonitis, was more pronounced in the elderly patients receiving combined-modality therapy for locally advanced NSCLC. Despite increased toxicity, elderly patients have survival rates equivalent to younger individuals. Therefore, fit, elderly patients with locally advanced NSCLC should be encouraged to receive combined-modality therapy, preferably on clinical trials with cautious, judicious monitoring. Future studies should explore ways to decrease toxicity of therapy in elderly patients. (C) 2003 by American Society of Clinical Oncology.