Faculty Collaboration Database

Age is independent of comorbidity influencing patient selection for combined modality therapy for treatment of stage III nonsmall cell lung cancer (NSCLC). Am J Clin Oncol 2006 Jun;29(3):252-7

Date

06/07/2006

Pubmed ID

16755178

DOI

10.1097/01.coc.0000217824.20290.ab

Scopus ID

2-s2.0-33745009238 (requires institutional sign-in at Scopus site)   48 Citations

Abstract

OBJECTIVES: To determine the influence of age and comorbidity in patient selection for treatment of stage III NSCLC with combined modality therapy (CMT).

METHODS: There were 102 patients with a Karnofsky Performance Score greater than or equal to 70, and clinical stage III NSCLC analyzed retrospectively for comorbidity. All patients received radiotherapy, and 57 (56%) received CMT with sequential and/or concurrent chemotherapy. Comorbidity was rated retrospectively using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). The effect of an extremely severe comorbidity score on patient selection and overall survival (OS) was evaluated.

RESULTS: Presence of a grade 4 comorbidity (P = 0.02) and use of radiation only (P < 0.01) were associated with a statistically significant inferior OS on multivariate analysis, whereas age greater than or equal to 70, clinical stage IIIB, >5% weight loss, and radiation dose >63 Gy were not. Patients receiving CMT were significantly younger (P < 0.001), with less comorbidity (P < 0.001), and weight loss (P = 0.003) compared with patients receiving radiotherapy alone. A multivariate analysis revealed that age (P < 0.001), comorbidity (P = 0.007), and weight loss (P = 0.002) were independent factors influencing patient selection for CMT.

CONCLUSIONS: Age effects patient selection for CMT independent of comorbidity and weight loss in patients with stage III NSCLC and good performance status. This might be related to physician's biases regarding tolerability of CMT in the elderly, and might explain under-representation of elderly in clinical trials of lung cancer. Comorbidity assessment should be included in protocols studying locally advanced stage NSCLC and may be useful for stratification.

Author List

Firat S, Pleister A, Byhardt RW, Gore E

Authors

Selim Firat MD Professor in the Radiation Oncology department at Medical College of Wisconsin
Elizabeth M. Gore MD Professor in the Radiation Oncology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Age Factors
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung
Combined Modality Therapy
Comorbidity
Female
Geriatric Assessment
Humans
Karnofsky Performance Status
Lung Neoplasms
Male
Patient Selection
Retrospective Studies
Survival Analysis
Weight Loss