Altmışbeş Yaş Üstü Küçük Hücreli Dışı Akciğer Kanserinde Tedavi Modalitelerinin Karşılaştırılması

Abstract

This is a retrospective analysis of patients older than 65 years, who were treated and followed-up for non small cell lung cancer (NSCLC) between 2001-2012 at Medical Oncology Unit of Hacettepe University Medical School. We aimed to evaluate the response rates and survival data of the patients from file records. The files of 151 patients were suitable for analysis and they represented 33.11% of all non small cell lung cancer cases older than 65 years who were followed up at our center. The mean age of the patients was calculated as 70.19±4.93. Charlson comorbidity index was calculated taking into consideration the comorbid diseases and second malignancies of the patients. Charlson comorbidity index ranged between 2 and 7. The comorbidity indices showed a parallel rise with increasing age at diagnosis (p<0.05). The most common histology was adenocarcinoma (57.6%). Twenty-eight patients (18.7%) had undergone curative surgery and eleven of these cases had not received adjuvant treatment. The reasons for not delivering adjuvant therapy to these patients were, stage IA disease in 8 patients, comorbidities and poor performance status in 3 patients. Progression-free survival and overall survival of the remaining patients who received adjuvant therapy were 32 weeks (SD:2.9; 95% CI: 26.2-37.8 weeks) and 74.5+ months, respectively. Eleven (57.9%) of 19 patients with locally advanced disease had received radiotherapy. Two patients received adjuvant radiotherapy following chemotherapy and 6 of the remaining 9 patients were treated with concurrent chemoradiotherapy. These cases received platinum-based combination therapy. Three patients were treated with radiotherapy alone, in the first-line setting. Among patients with metastatic disease, paclitaxel-platinum combination (43.8%) was the most commonly used first- line regimen. In this group, time to progression was 66 weeks (SD:19.1; 95% CI: 28.6-103.4 weeks) (median 16 weeks and 70+ weeks in monotherapy and combination arms, respectively). The v difference between the treatment groups was statistically significant (p=0.038). However, this difference did not have an impact on the overall survival (median 28 months and 34.5+ months in combination and monotherapy arm, respectively) (p=0.86). Single agent therapy was more frequently used in the second (77.6%) and the third- line (62.5%) treatments. Patients in the monotherapy arm more frequently received 2nd, 3rd and 4th line treatment compared to the combination arm. Karnofsky Performance Status (KPS) was found to be the only determinant to effect overall survival. Overall survival was 92.44+ weeks in patients with performance status of 0 and 1, whereas 13.17+ weeks in patients with performance status of 2 and 3 (p<0.05). In conclusion, age should not be the only factor to be taken into account when planning the treatment of geriatric patients, but performance status and comorbidities should be considered as well.