1. Accelerated radical radiotherapy for Non Small Cell Lung Cancer: Single centre audit outcome of two fractionations in the treatment of the elderly patients
Robinson SD, Absalom KAR, Das T, Lee C, Fisher PM, Bates E, Hatton MQ
Department of Clinical Oncology, Weston Park Hospital, Sheffield
Background:
Radical radiotherapy (RT) regimens for NSCLC vary considerably and there is little data on outcomes for elderly patients who are underrepresented in clinical trials. In routine practice our centre has used continuous hyperfractionated accelerated radiotherapy (CHART, 54Gy in 36 fractions, Figure 1) and accelerated hypofractionated RT (55 Gy in 20 fractions, Figure 2) since We have audited outcomes for patients over the age of 80 treated between 2005 – 2011.
Results - Demographics and Treatment:
Of the 516 patients received radical radiotherapy 73 were over 80 years old with 71% being male and 85% WHO performance status 0-1. PET staging was performed in 87% with 41%, 22% and 32% being stage 1, 2, 3 respectively. 51% were squamous carcinomas, 18% non-squamous, 12% NOS with 19% without a confirmed histological diagnosis. 2 patients received primary chemotherapy, with 40% receiving CHART and 56% hypofractionated RT (Figure 3). All completed their prescribed radiotherapy treatment.
Results - Survival:
2 year survival was 67% and median overall survival (OS) from time of diagnosis was 22 months. Univariate subgroup analysis showed stage as the only statistically significant variables affecting survival (Figure 4).
Figure 4. Kaplan-Meier plot of Overall Survival and significance levels from a univariate analysis for individual variables
p Value
Gender
0.468 PS
0.685
Histology
0.218
Stage
0.005
PET
0.669
Regime
0.518
Age
0.271
Figure 3. Pie charts representing proportions of patients in each sub-group
Discussion:
This audit has confirmed accelerated radiotherapy schedules are deliverable to the elderly population with NSCLC who were generally not considered suitable for standard treatment with chemo-radiotherapy. The outcomes are similar to those reported in our younger patient cohorts [1] and appear to be as good as those reported in the original CHART paper [2].
Materials and methods
Case notes and radiotherapy records for all patients receiving radical radiotherapy were retrospectively reviewed. Basic patient demographics, tumour characteristics, RT and survival data were collected. Descriptive statistical analysis and Cox regression analysis was performed using SSPS.
Conclusions:
The use of accelerated radiotherapy fractionations for the radical treatment of elderly patients with NSCLC is a feasible and well tolerated treatment for those patients not suitable for a chemo-radiotherapy approach. Outcomes are encouraging but trials specific to this population are needed to define the best radiotherapy fractionations in this elderly population.
References:
1.Pemberton LS, Din OS, Fisher PM, Hatton MQ. Accelerated radical radiotherapy for non-small cell lung cancer (NSCLC) using two common regimens: a single centre audit of outcome. Clinical Oncology 2009;21:161-7
2. Saunders M et.al. Continuous hyperfractionated accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small-cell lung cancer: a randomised multicentre trial. CHART Steering Committee. Lancet Jul 19;350(9072):161-5