Non small cell lung cancer in the elderly: clinico-pathologic, management and outcome characteristics in comparison to younger patients

• Published in: Journal of chemotherapy (Florence) Vol. 21; no. 5; p. 573
• Main Authors: Koumarianou, A, Fountzilas, G, Kosmidis, P, Klouvas, G, Samantas, E, Kalofonos, C, Pentheroudakis, G, Economopoulos, T, Pectasides, D
• Format: Journal Article
• Language: English
• Published: England 01.10.2009
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - therapy; Age Factors; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carcinoma, Large Cell - mortality; Carcinoma, Large Cell - secondary; Carcinoma, Large Cell - therapy; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - secondary; Carcinoma, Non-Small-Cell Lung - therapy; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - secondary; Carcinoma, Squamous Cell - therapy; Chemotherapy, Adjuvant; Cohort Studies; Combined Modality Therapy; Female; Humans; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - therapy; Middle Aged; Neoplasm Staging; Prognosis; Radiotherapy, Adjuvant; Registries; Survival Rate; Treatment Outcome
• ISSN: 1973-9478
• DOI: 10.1179/joc.2009.21.5.573

It is controversial whether non-small cell lung cancer (NSCLC) in the elderly constitutes a distinct clinico-biological entity compared to younger counterparts. As reported data are scant and discordant, we sought to analyze retrospectively the medical records of Hellenic NSCLC patients aged >70 years and compare them with those of age (70-45 years) and younger (<45 years) patients. Records were abstracted from the Hellenic Cooperative Oncology Group (HeCOG) cancer registry database. Presentation, management and outcome data of 417 elderly patients aged > or =70, 1374 age 70-45 years old and 115 patients aged < or =45 years old with histologically confirmed NSCLC managed from 1989 until 2004 were retrieved and compared. Elderly patients differed significantly in terms of presence of symptoms (p<0.001), including thoracic pain (p=0.003), dyspnea (p<0.001), cough (p<0.001) and fatigue (p<0.001), eastern Cooperative Oncology Group performance status (PS) 2-3 (p<0.001), and histological type (more commonly diagnosed with squamous cell carcinoma (p<0.002) and less frequently with adenocarcinoma). Although elderly patients had significantly higher rates of PS 2-3, they had significantly better median time to disease progression (TTP) compared to the younger counterpart (6.4 versus 4.3 months p=0.047). Overall survival (OS) was not significantly different between elderly and young patients (median OS 11.8 versus 11.5 months; p=0.6), but platinum-based chemotherapy and radiotherapy were variables associated favorably with TTP and survival in the elderly. This large retrospective series presents strong evidence that NSCLC constitutes a similar clinicopathologic entity in elderly and young individuals with discretely differing biological behavior and that elderly symptomatic patients should be considered for effective anticancer treatment whenever possible.