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Fit Elderly Patients with Limited Stage Small Cell Lung

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Cancer Can Withstand Radiation



SCOTTSDALE, Ariz.-Patients older than 70 with limited-stage small-cell lung cancer (SCLC) can be successfully treated with aggressive radiation so long as they are relatively fit when treatment is initiated, according to a study published online in Cancer.

Although radiation therapy for this age group results in a greater likelihood of morbidity, doctors should offer the treatment to these patients, said Steven Schild, M.D., a professor of oncology at the Mayo Medical School and a radiation oncologist at the Mayo Clinic, Scottsdale (Ariz.), reported Monday.

"Despite having more weight loss, poorer performance status, increased pulmonary toxicity and more deaths due to treatment, survival was not found to be significantly worse in older individuals," said Dr. Schild and colleagues as part of a study to be published June 1.

"Fit elderly patients with locally advanced small-cell lung cancer should be encouraged to receive combined-modality therapy," they added.

After five years the survival rate in the older group of patients was 17% while the younger patients in the study had a survival of 22%, a difference that did not reach statistical significance (p=0.14).

In the Phase III trial, 263 patients were enrolled to examine whether patients given chemotherapy with etoposide and cisplatinum had better outcomes with added radiation once or twice a day. The study showed no difference. The study was then also examined to see if age made a difference in outcome, comparing 209 patients under the age of 70 to 54 patients over the age of 70.

Again, Dr. Schild reported, there were no significant differences. The patients in the trial were diagnosed with limited stage small cell lung cancer and had to have a performance status less than 2, under the Eastern Cooperative Oncology Group criteria.

Both age groups responded well to treatment. Dr. Schild noted that 196 (93.6%) of the younger patients had a "better than stable disease" response, compared with 51 (94.4%) of the patients over the age of 79 (p=0.32).

In reviewing the incidence of toxicity, researchers found no cases of pneumonitis in the younger patients, and six cases among the other individuals, a difference that achieved statistical significance at the p=0.008 level.

Dr. Schild suggested that the results of his trial may be limited because older patients who were not in a fit condition may not be represented in the trial.

"Elderly patients may experience greater toxicity due to preexisting illnesses, decreased clearance of chemotherapy and limited bone marrow reserves," the researchers said. "Therefore, physicians should be more cautious when monitoring the effects of therapy in elderly patients."

Dr. Schild suggested that future studies examine ways of reducing the morbidity in older individuals.

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