This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gridelli, C. Articles by Schild, S. E. Search for Related Content PubMed PubMed Citation Articles by Gridelli, C. Articles by Schild, S. E. Social Bookmarking                            What's this?

Lung Cancer in the Elderly

Cesare Gridelli, Corey Langer, Paolo Maione, Antonio Rossi, Steven E. Schild

From the Division of Medical Oncology, "S.G. Moscati" Hospital, Avellino, Italy; Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA; and the Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ

Address reprint requests to Cesare Gridelli, MD, Division of Medical Oncology, "S.G. Moscati" Hospital, Contrada Amoretta, 83100 Avellino, Italy; e-mail: cgridelli{at}libero.it

Purpose Elderly patients often have comorbidities and other characteristics that make the selection of treatment daunting.

Methods We have reviewed the available evidence in the literature to gauge the results of therapy for elderly lung cancer patients.

Results The beneficial results achieved with adjuvant chemotherapy in the general population with early non–small-cell lung cancer (NSCLC) cannot be automatically extrapolated to the elderly, who are at higher risk of toxicity. Retrospective analyses of combined chemoradiotherapy in locally advanced NSCLC patients suggest equivalent therapeutic benefit for younger and older patients, despite heightened toxicity. There have been no elderly-specific phase III trials for locally advanced NSCLC. For advanced NSCLC, on the basis of evidence-based data, single-agent chemotherapy remains the standard of care for nonselected elderly patients. However, retrospective analyses suggest that the efficacy of platinum-based combination chemotherapy is similar in fit older and younger patients, with increased but acceptable toxicity for elderly patients. In limited-disease small-cell lung cancer (SCLC), sequential chemoradiotherapy is clearly less toxic compared with a standard concurrent approach, but our assessment of treatment is hindered by the absence of prospective elderly-specific trials. Although prophylactic cranial irradiation has emerged as a standard strategy, it should be omitted in patients with cognitive impairment. In extensive SCLC, etoposide in combination with either cisplatin or carboplatin has emerged as standard treatment; hematopoietic support may be necessary.

Conclusion With the exception of advanced NSCLC, prospective elderly-specific studies are lacking. Available data suggest that outcomes in the fit elderly mirror results observed in younger patients, although toxicity is generally worse.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				K. Okamoto, I. Okamoto, K. Takezawa, I. Tachibana, M. Fukuoka, Y. Nishimura, and K. Nakagawa Cisplatin and Etoposide Chemotherapy Combined with Early Concurrent Twice-daily Thoracic Radiotherapy for Limited-disease Small Cell Lung Cancer in Elderly Patients Jpn. J. Clin. Oncol., October 16, 2009; (2009) hyp137v1. [Abstract] [Full Text] [PDF]

				D. A. Nikolova, I. A. Asangani, L. D. Nelson, D. P.M. Hughes, D. R. Siwak, G. B. Mills, A. Harms, E. Buchholz, L. R. Pilz, C. Manegold, et al. Cetuximab Attenuates Metastasis and u-PAR Expression in Non-Small Cell Lung Cancer: u-PAR and E-Cadherin are Novel Biomarkers of Cetuximab Sensitivity Cancer Res., March 15, 2009; 69(6): 2461 - 2470. [Abstract] [Full Text] [PDF]

				D. D. Ruysscher, A. Botterweck, M. Dirx, M. Pijls-Johannesma, R. Wanders, M. Hochstenbag, A.-M. C. Dingemans, G. Bootsma, W. Geraedts, J. Simons, et al. Eligibility for concurrent chemotherapy and radiotherapy of locally advanced lung cancer patients: a prospective, population-based study Ann. Onc., January 1, 2009; 20(1): 98 - 102. [Abstract] [Full Text] [PDF]

				S. M. Lichtman, L. Balducci, and M. Aapro Geriatric Oncology: A Field Coming of Age J. Clin. Oncol., May 10, 2007; 25(14): 1821 - 1823. [Full Text] [PDF]