The study on importance of three-dimensional radiotherapy for elderly patients with stage ⅠV non-small cell lung cancer
ZHANG Bo*, LU Bing, SU Sheng-fa, HU Yin-xiang, OUYANG Wei-wei, LI Hui-qin, MA Zhu, LONG Jin-hua
*Department of Oncology, Ahshun People Hospittal,Anshun 561000,China Corresponding author:LU Bing,Department of Oncology,Guizhou Province Tumor Hospital;Department of Thoracic Oncology, Affiliated Hospital of Guiyang Medical College; Guiyang 550004,China; Email:lbgymaaaa@sohu.com
Abstract：Objective To evaluate the importance of three-dimensional radiotherapy for elderly patients of stage ⅠV non-small cell lung cancer (NSCLC). Methods Comparing with treatment outcome of ≥65 years 67 patients and<65 years 134 patients using concurrent chemotherapy and thoracic three-dimensional radiotherapy during 2003 to 2010 years. Survival analysis was taken by Kaplan-Meier method. The multivariate prognosis was analyzed by Cox model. Results The follow-up was 97.8%. The percentage of ≥65 years and<65 years patients accepted with concurrent 4－5 cycles chemotherapy were 30% and 55%, and with 42% and 49% patients with radiotherapy ≥63 Gy. The median survival time (MST) were 17 months and 14 months (χ2=0.76,P=0.384) for ≥65 years and<65 years patients accepted with concurrent 4－5 cycles chemotherapy concurrent ≥63 Gy radiotherapy respectively. The MST and 1-, 2-,3-year overall survival rate were 17 months and 8 months,65% and 23%, 30% and 13%, 24% and 9%(χ2=7.90,P=0.005) for whole groups patients treated with chemotherapy concurrent ≥63 Gy and<63 Gy radiotherapy. And the MST of patients ≥63 Gy was significantly longer than those with<63 Gy either concurrent chemotherapy any cycles (χ2=9.54,P=0.023).The MST were 14 months and 8 months (χ2=1.82,P=0.178),17 months and 17 months (χ2=0.47,P=0.492) for ≥65 years and ≥63 Gy radiotherapy patients accepted with concurrent 4－5 cycles and 2－3 cycles chemotherapy concurrent respectively. Multivariate analysis showed local response (β=0.600,P=0.003) and numbers of tumor metastasis (β=0.670,P=0.040) were independent factors for survival. Conclusions For a part of elderly patients of stage Ⅳ NSCLC, concurrent chemotherapy and thoracic three-dimensional radiotherapy can prolong survival time with acceptable toxicity. Perhaps radiotherapy is more important.
ZHANG Bo*,LU Bing,SU Sheng-fa et al. The study on importance of three-dimensional radiotherapy for elderly patients with stage ⅠV non-small cell lung cancer[J]. Chinese Journal of Radiation Oncology, 2012, 21(6): 504-507.
[1] Weir HK, Thun MJ, Hankey BF, et al. Annual report to the nation on the status of cancer, 1975－2000, featuring the uses of surveillance data for cancer prevention and control. J Natl Cancer Inst,2003,95:1276-1299. [2] Gridelli C, Perrone F, Monfardini S, et al. Lung cancer in the elderly. Eur J Cancer,1997,33:2313-2314. [3] Bunn PA Jr, Lilenbaum R. Chemotherapy for elderly patients with advanced non-small cell lung cancer. J Natl Cancer Inst,2003,95:341-343. [4] 赵平,陈万青.2009中国肿瘤登记年报.北京:军事医学科学出版社,2010:89. [5] Asmis TR, Ding X, Seymour L, et al. Age and comorbidity as independent prognostic factors in the treatment of non-small cell lung cancer:a review of national cancer institute of Canada clinical trials group trials. J Clin Oncol,2008,26:54-59. [6] Yancik R. Cancer burden in the aged:an epidemiologic and demographic overview. Cancer,1997,80:1273-1283. [7] Ramalingam S, Perry MC, Larocca DA, et al. Outcome of elderly (>70 years) non-small cell lung cancer (NSCLC) patients on multicenter, phase Ⅲ randomized trial comparing weekly vs standard schedules of paclitaxel (P) plus carboplatin (C). J Clin Oncol,2005,23:16S. [8] Alam N, Shepherd FA, Winton T, et al. Compliance with post-operative adjuvant chemotherapy in non-small cell lung cancer:an analysis of National Cancer Institute of Canada and intergroup trial JBR10 and a review of the literature. Lung Cancer,2005,47:385-394. [9] Kramer GW, Wanders SL, Noordijk EM, et al. Results of the Dutch national study of the palliative effect of irradiation using two different treatment schemes for non-small cell lung cancer. J Clin Oncol,2005,23:2962-2970. [10]苏胜发,卢冰,张波,等.Ⅳ期非小细胞肺癌化疗同期胸部三维 放射治疗的前瞻性研究(一)——疗效与不良反应.中华放射肿瘤学杂志,2011,20:463-472. [11] Schiller JH, Harrington D, Belani CP, et al. Comparison of four chemotherapy regimens for advanced non-small cell lung cancer. NEJ Med,2002,346:92-98. [12] Owonikoko TK, Ragin CC, Belani CP, et al. Lung cancer in elderly patients:an analysis of the surveillance, epidemiology, and end results database. J Clin Oncol,2007,25:5570-5577. [13] Non-small cell lung cancer co-operative group. Chemotherapy in non-small cell lung cancer:a meta-analysis using updated data on individual patients from 52 randomized clinical trials. BMJ,1995,311:899-909. [14] Nagata Y, Takayama K, Matsuo Y, et al. Clinical outcomes of a phase Ⅰ/Ⅱ study of 48 Gy of stereotactic body radiotherapy in 4 fractions for primary lung cancer using a stereotactic body frame. Int J Radiat Oncol Biol Phys,2005,63:1427-1431. [15] Xia TY, Li HQ, Sun QX, et al. Promising clinical outcome of stereotactic body radiation therapy for patients with inoperable stage Ⅰ/Ⅱ non-small cell lung cancer. Int J Radiat Oncol Biol Phys,2006,66:117-125. [16] Onishi H, Nagata Y, Arimoto T, et al. Stereotactic body radiotherapy (SBRT, BED>100 Gy) for operable stage Ⅰ non-small cell lung cancer:is SBRT comparable to surgery? Int J Radiat Oncol Biol Phys,2007,69 Suppl:86-87. [17] Rusch V, Albain K, Turrisi A, et al. Phase trial of concurrent chemo-therapy and radiotherapy (CT/RT) vs. CT/RT follow by surgical resection for stage ⅢA(pN2) non-small cell lung cancer (NSCLC):outcomes and implications for surgical management in north American intergroup 0139(RTOG 9303). Lung Cancer,2005,49 Suppl 2∶515. [18] Meerbeeck JV, Schil PV, Kramer G, et al. A randomized trial of radical surgery (S) versus thoracic radiotherapy (TRT) in patients (pts) with stage ⅢA-N2 non-small cell lung cancer (NSCLC) after Response to induction chemotherapy (ICT)(EORTC 08941). Lung Cancer,2005,49 Suppl 2:514. [19] Xanthopoulos1 E,Fernandes1 AT, Apisarnthanarax1 S, et al. Definitive dose thoracic radiotherapy in oligometastatic stage Ⅳ non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys,2011,81 Suppl 2:S620. [20] 张波,卢冰,苏胜发,等.化疗同期胸部三维放射治疗Ⅳ期非小细胞肺癌的可行性研究.中国癌症防治杂志,2011,3:218-222.
2012, Vol. 21 
