[DG News] 65세 이상 고령의 폐암 환자도 적극적 방사선치료가 가능하다

아래 내용은 고려의 환자일 수록 전신상태나 제반 요소를 고려할 때 공격적인 방사선 치료를 견디기 힘들 것이라는 일반적인 기대와 달리 실제 추적관찰에서는 오히려 방사선에 의한 식도염 등의 부작용이 상대적으로 어린 환자들보다 더 적었다는 연구이다. 따라서 나이에 상관없이 적극적으로 치료하겠다는 내용이다.

※출처 : DG News

Lower Incidence of Esophagitis in Elderly Patients With NSCLC Undergoing Definitive Radiation

February 1, 2017

DENVER -- February 1, 2017 -- Elderly patients with non-small-cell lung cancer (NSCLC) undergoing definitive radiation have a lower incidence of esophagitis compared with younger patients, and tolerate aggressive standard treatment regimens, according to a study published in the Journal of Thoracic Oncology.

A large proportion of patients with lung cancer are aged older than 65 years and are often poorly represented in clinical trials, undertreated, or don't receive aggressive standard treatment due to concerns about their ability to tolerate aggressive treatment regimens.

While elderly patients are not different than younger patients in their willingness to accept aggressive treatment, even elderly patients with good performance status and lack of comorbidities are less likely than younger patients to be offered aggressive treatments on the basis of age.

Radiotherapy is the standard treatment regimen for locally advanced NSCLC, but can lead to esophagitis and radiation pneumonitis.

For the current study, Payal D. Soni, MD, University of Michigan, Ann Arbor, Michigan, and colleagues evaluated elderly patients undergoing definitive lung radiation to assess how the elderly tolerate treatment compared with younger patients.

Patients undergoing definitive radiation for lung cancer with or without chemotherapy from 2004 to 2013 were identified from a prospective institutional database in which patients of all ages were eligible for inclusion (UM cohort). Patients were excluded if they were treated with stereotactic body radiation therapy (SBRT) or if complete dosimetric information was not available for review.

Logistic regression modelling was performed to assess the impact of age on esophagitis grade ≥3 or ≥2 and pneumonitis grade ≥3 or ≥2, adjusting for oesophageal and lung dose, chemotherapy utilisation, smoking status, and performance status. The analysis was validated in a large cohort of 691 patients from the Michigan Radiation Oncology Quality Consortium (MROQC) registry -- an independent state-wide prospective database.

There were 179 patients extracted from the UM cohort, of which, after exclusions, 125 patients with lung cancer were included in the analysis. The median age in the UM cohort was 66 years, with 34% of the patients being aged older than 70 years.

Among the 125 patients in the UM cohort, 49 (39%) experienced grade ≥2 and 14 (11%) experienced grade ≥3 esophagitis. Of the 125 patients, 82 patients were <70 years and 48% experienced grade ≥2 and 16% experienced grade ≥3 esophagitis. Conversely, among the 43 patients aged ≥70 years, these rates were 23% (grade ≥2) and 2% (grade ≥3).

Multivariate regression modelling of the UM cohort revealed a significant inverse correlation between age and rate of esophagitis for both grade levels. The same association was noted in the MROQC cohort, which validated these results. There was no significant association between age and pneumonitis.

“Our study demonstrates significantly decreased incidence of radiation esophagitis in elderly patients,” the authors wrote. “This finding remained significant even after adjusting for oesophageal dose, concurrent chemotherapy, history of smoking, and performance status. In patients who are never smokers with good performance status, who received high doses of radiation to the oesophagus with concurrent chemotherapy, the probability of esophagitis for a 70-year-old is approximately one-third that of an identical 50-year-old patient. Pattern of care studies suggest that the elderly are being undertreated for various malignancies including lung cancer, independent of other variables including performance status. Our study undermines this practice and supports standard definitive treatment for the elderly with good performance status.”

SOURCE: International Association for the Study of Lung Cancer