SESSION TITLE: Lung Cancer Posters II
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM
PURPOSE: Small cell lung cancer (SCLC) is increasingly diagnosed in elderly, but there is insufficient evidence in regards to optimal treatment strategy. We evaluated patients ≥80 years with SCLC, their characteristics, modes of treatment, response and outcomes.
METHODS: We conducted a retrospective study of patients aged ≥80 who were diagnosed with SCLC and followed up at two of our institutions between October 2001 and December 2011.
RESULTS: A total of 6333 lung cancer patients were screened. 759 (12%) patients were ≥80 years old, out of these 72 (9%) were SCLC. 4 patients were excluded due to lack of follow up and remaining 68 patients were analyzed. The median age at diagnosis was 82 years (range 80-94). The majority of patients had extensive stage disease (65%, 42/65), with 46% (30/65) having metastatic disease at the time of diagnosis. 31% (20/64) of patients received no treatment. 27% (17/64) were treated with chemotherapy only, 11% (7/64) received radiation only, and 28% (18/64) received combination with chemotherapy and radiation. The estimated median overall survival (OS) of this cohort was 3.8 months (95% C.I. 1.9-6.7). Overall 79% (30/38) of patients with data responded to treatment - 39% (15/38) complete responders (CRs) and 39% (15/38) partial responders (PRs). 64 (94%) patients died during follow up. The 1 and 2-year survival rates were estimated to be 16% +5 and 8% + 3%, respectively. Patients with limited disease had better performance status than patients with extensive disease (74% ECOG PS 0, 1 versus 38%, respectively, p=.01), and tended to receive chemotherapy and radiation more frequently (48% versus 18%, respectively, p=.08). The limited disease patients had better response to treatment compared to extensive disease (67% CRs versus 22%, p=.006). In multivariable analysis, ECOG PS (0, 1 versus 2, 3, 4) [HR 5.56 CI (2.74-11.36); p<.0001] and stage (extensive versus limited) [HR 2.26 CI (1.22-4.17) p<.009] were identified as independent prognostic factors for overall survival.
CONCLUSIONS: Patients with better performance status and limited stage disease appear to respond well when treated with chemotherapy or concurrent chemo-radiation therapy. However, prognosis remains poor. This study is limited by small number and retrospective nature.
CLINICAL IMPLICATIONS: Elderly patients with SCLC should not be denied standard therapy based on age. Performance status (PS), disease stage and physiological age should be used to guide therapeutic decisions in this challenging group of patients.
DISCLOSURE: The following authors have nothing to disclose: Nirosshan Thiruchelvam, Iuliia Kim, Jaskirat Randhawa, Frunze Petrosyan, Hamed Daw, Timothy Spiro, Gaurav Kistangari, Paul Elson, Abdo Haddad
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