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I. Brao

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    MINI 33 - Radiotherapy and Complications (ID 164)

    • Event: WCLC 2015
    • Type: Mini Oral
    • Track: Treatment of Locoregional Disease – NSCLC
    • Presentations: 1
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      MINI33.11 - Locally Advanced NSCLC Elderly Patients Assessed by Multidimensional Geriatric Assessment and Treated with Concurrent Chemoradiation (ID 2867)

      18:30 - 20:00  |  Author(s): I. Brao

      • Abstract
      • Slides

      Despite the increasing number of elderly patients (p) with unresectable stage III NSCLC p presenting to our clinic, there is no consensus on the therapeutic approach to these p. The comprehensive geriatric assessment (CGA) and the comorbidity measurement are relevant tools to identify p who may benefit from tolerable combinations of concurrent chemoradiation (CRT).

      Elderly p (≥75 years) with stage III NSCLC underwent multidimensional geriatric assessment (MGA) that incorporated validated instruments to assess comorbidity, polypharmacy, functional status, geriatric syndromes (GS), mood, cognition and vulnerability. P were classified according to the MGA results into 3 risk groups: (1) fit p: independent in all ADL and IADL, no comorbidities and absence of GS; (2) vulnerable p: <3 comorbidities and/or <3 IADL but no ADL disability and absence of GS; (3) dependent p: ≥3 disabilities or presence of GS. P classified into group 1 and 2 were considered candidates for antitumoral treatment, whereas patients into group 3 were candidates to best support care. Clinical, GA and follow-up data were prospectively collected. Overall survival (OS) was calculated using Kaplan-Meier method and the median follow-up time was 13.5 months.

      From July 2008 to November 2014, 54 elderly p with stage III NSCLC were identified. The median age was 80 years (74-87) and most p (93%) were males. The most common histological subtype was squamous cell carcinoma (54%), followed by adenocarcinoma (28%) and NOS (18%). MGA classified 20 p (37%) as fit, 23 p (43%) as vulnerable and 11 p (20%) as dependent. Median number of comorbidities: 4 (0-11); median number of drugs: 6 (0-12); median Karnofsky: 80% (60-100); median Barthel: 95 (80-100); Lawton-Brody Scale (<4/≥4): 18%/82%; Pfeiffer (<4/≥4): 89%/11%; Yesavage test (0/≥1): 54%/46%; 1 (0-10); median GS: 1 (1-3); VES-13 (<3/≥3): 50%/50%. Risk groups 1 and 2 had significantly better median OS (20 and 17.5 months, respectively) as compared with group 3 (7.7 months, p=0.004). The number of p treated with concurrent CRT was higher among fit patients (14; 70%) as compared with group 2 (8; 35%) and 3 (0; 0%). Some fit and vulnerable p did not receive concurrent CRT due to patient and physician decision, tumor not amenable for radiotherapy or comorbid conditions. P treated with concurrent CRT received conventional 3D thoracic radiotherapy (2 Gy/fraction) in combination with carboplatin AUC 2.5 and vinorelbine 15 mg/m2 on days 1, 8, 21 and 29. Overall response rate was 68%. Median OS was 22 months (95% CI 10.6 – 33.6). There were no differences in OS when comparing risk groups 1 and 2 (p=0.446). Adverse events (G3-4): neutropenia, 2p (9%); anemia, 1p (4.5%); thrombocytopenia 1p (3%); febrile neutropenia, 1p (3%); pneumonia, 1p (3%); tracheo-bronchial infection, 3p (14%); asthenia 2p (9%); anorexia 1p (4.5%); diarrhea, 1p (4.5%); radiation pneumonitis, 3p (14%) and oesophagitis 0p (0%). Three p (14%) died due to radiation pneumonitis and 1 p (3%) due to a respiratory infection.

      MGA may help in the selection of elderly p for concurrent CRT and appeared to be a valuable tool to avoid undertreatment of those p.

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