Age and treatment of non-small-cell lung cancer: a database analysis in elderly patients

The present study was conducted to determine whether it is justifiable to adapt treatment to age in patients with non-small-cell lung cancer (NSCLC). All NSCLC patients treated at the Institut Jules Bordet who were 75 years old or over were prospectively entered in our database. Patients were divided into those who were "eligible" and those who were "ineligible" for clinical trials according to the standard criteria used by the ELCWP. The 604 consecutive patients treated for NSCLC between March 1995 and August 2001 included 60 (9.9%) aged 75 years or over. Their principal characteristics were as follows: median age 78 years (75-93); male-to-female ratio 45/15; stages I/II/III/IV in 16/1/23/18 cases (in 2 cases complete work-up was refused by the patient); squamous/glandular/other histology in 23/24/13 cases; the median performance status was 70 (30-100). Except for their age, 37 patients met the eligibility criteria for the ELCWP standard treatment study protocol in progress during the study period. Twenty-five patients received an adequate treatment according to the stage of the disease, and 5 (13.5%) refused conventional therapy and received less aggressive treatment or none at all. For 7 (18.9%) patients, an adapted treatment was chosen solely on the basis of their age. For patients with disease in stages I-III who underwent adequate treatment survival rates were equivalent to the results found in the literature, with median survival times of 770 days and 262 days for those with stage I-II and those with stage III disease, respectively. Survival rates for patients with stage IV disease ranged from 10 days to 17 months. NSCLC patients 75 years of age or more without significant co-morbidities can probably be treated in the same way as younger people with similar survival rates if their disease is in stages I-III. Because the number of patients was too small, our data do not allow us to provide meaningful conclusions for stage IV disease.