Chemoradiotherapy has benefits for older lung cancer patients

Adding low-dose carboplatin to radiotherapy prolongs the survival of elderly people with non-small-cell lung cancer (NSCLC), according to a Lancet Oncology study published online this week (22 May 2012).

Despite more than two-thirds of lung cancer cases being diagnosed in people aged 65 years or older, there have been few trials in this age group and it is not known if chemoradiotherapy is suitable for elderly patients, say the authors.

Researchers from the Japan Clinical Oncology Group randomly assigned 200 patients aged 71 years or older with stage III NSCLC, which could not be removed by surgery, to low-dose carboplatin plus radiotherapy or radiotherapy alone.

Patients given chemoradiotherapy had a median overall survival of 22.4 months, compared with 16.9 months for those given radiotherapy alone (hazard ratio 0.68, 95.4 per cent confidence interval 0.47?0.98, P=0.0179). This magnitude of survival advantage for chemoradiotherapy is unexpectedly large, according to the authors of an accompanying editorial (ibid) (see Panel).

More than half of patients who received chemoradiotherapy experienced haemotological toxic effects, including leucopenia and neutropenia, compared with none in the radiotherapy group. According to Fiona MacLean, lead pharmacist in cancer care at NHS Greater Glasgow & Clyde, this increased toxicity makes chemoradiotherapy a challenge to administer to elderly patients with multiple co-morbidities.

Although the study authors recommend that the combined therapy should be considered, Ms MacLean said: "Implementation of daily concurrent chemoradiation for 20 days would present logical challenges for cancer centres and, indeed, the patients would need to be committed to being present in the treatment location for a considerable time each day.

"The timing of the carboplatin dose is one hour prior to radiotherapy and such a change would impact on both pharmacy and radiotherapy services."

The study authors point out that previous studies have shown that median survival for patients who receive combined therapies hovers around 17 months ? the same as the median survival achieved in the present study with radiation alone. They say: "An important question is why was survival better in [this trial] than in prior studies . . . It is possible that selection of a relatively healthy cohort of older patients, or those with less advanced stage III disease, might have led to the improved survival noted in the present study. "In this case, the results of the study may not be valid for the broader population of older patients with stage III NSCLC". Lead pharmacist in cancer care at NHS Greater Glasgow & Clyde Fiona MacLean also questioned whether the study population was representative of UK patients.

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