Geriatric assessment may help decision-making in elderly patients with inoperable, locally advanced non-small-cell lung cancer

• Published in: British journal of cancer Vol. 118; no. 5; pp. 639 - 647
• Main Authors: Antonio, Maite, Saldaña, Juana, Linares, Jennifer, Ruffinelli, José C, Palmero, Ramón, Navarro, Arturo, Arnaiz, Maria Dolores, Brao, Isabel, Aso, Samantha, Padrones, Susana, Navarro, Valentí, González-Barboteo, Jesús, Borràs, Josep Maria, Cardenal, Felipe, Nadal, Ernest
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 06.03.2018; Nature Publishing Group; Cancer Research UK
• Subjects: 692/4028/67/1059/99; 692/4028/67/1612/1350; 692/699/67/1059/485; 692/700/1518; Aged; Aged, 80 and over; Biomedical and Life Sciences; Biomedicine; Cancer Research; Carcinoma, Non-Small-Cell Lung - therapy; Chemoradiotherapy; Chemoradiotherapy - methods; Chemotherapy; Clinical Study; Consensus; Càncer de pulmó; Decision Making; Drug Resistance; Epidemiology; Female; Geriatria; Geriatric Assessment - methods; Geriatrics; Humans; Lung cancer; Lung Neoplasms - therapy; Male; Medical prognosis; Molecular Medicine; Multivariate analysis; Non-small cell lung carcinoma; Older people; Oncology; Palliative Care - methods; Palliative treatment; Platinum; Platinum - therapeutic use; Prospective Studies; Radiation; Radiation therapy; Spain; Survival Analysis; Thorax; Toxicity; Tractament pal·liatiu; Treatment Outcome; Spain; comprehensive geriatric assessment; locally advanced non-small-cell lung cancer; concurrent chemoradiotherapy; decision-making; elderly
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/bjc.2017.455

Background: Although concurrent chemoradiotherapy (cCRT) increases survival in patients with inoperable, locally advanced non-small-cell lung cancer (NSCLC), there is no consensus on the treatment of elderly patients. The aim of this study was to determine the prognostic value of the comprehensive geriatric assessment (CGA) and its ability to predict toxicity in this setting. Methods: We enrolled 85 consecutive elderly (⩾75 years) participants, who underwent CGA and the Vulnerable Elders Survey (VES-13). Those classified as fit and medium-fit by CGA were deemed candidates for cCRT (platinum-based chemotherapy concurrent with thoracic radiation therapy), while unfit patients received best supportive care. Results: Fit (37%) and medium-fit (48%) patients had significantly longer median overall survival (mOS) (23.9 and 16.9 months, respectively) than unfit patients (15%) (9.3 months, log-rank P =0.01). In multivariate analysis, CGA groups and VES-13 were independent prognostic factors. Fit and medium-fit patients receiving cCRT ( n =54) had mOS of 21.1 months (95% confidence interval: 16.2, 26.0). In those patients, higher VES-13 (⩾3) was associated with shorter mOS (16.33 vs 24.3 months, P =0.027) and higher risk of G3-4 toxicity (65 vs 32%, P =0.028). Conclusions: Comprehensive geriatric assessment and VES-13 showed independent prognostic value. Comprehensive geriatric assessment may help to identify elderly patients fit enough to be treated with cCRT.