Tarje Onsøien Halvorsen1,2, Stein Sundstrøm2, Øystein Fløtten3, Odd T Brustugun4,5, Paal Brunsvig4, Ulf Aasebø6,7, Roy M Bremnes7,8, Stein Kaasa1,3,4,5, Bjørn H Grønberg1,2. 1. a Department of Cancer Research and Molecular Medicine , NTNU, Norwegian University of Science and Technology , Trondheim , Norway. 2. b Clinic of Oncology, St. Olavs Hospital , Trondheim University Hospital , Trondheim , Norway. 3. c Department of Thoracic Medicine , Haukeland University Hospital , Bergen , Norway. 4. d Department of Oncology , Oslo University Hospital, The Norwegian Radium Hospital , Oslo , Norway. 5. e Institute of Clinical Medicine , University of Oslo , Oslo , Norway. 6. f Department of Pulmonology , University Hospital of North Norway , Tromsø , Norway. 7. g Department of Clinical Medicine, Faculty of Medicine , The Arctic University of Norway , Tromsø , Norway. 8. h Department of Oncology , University Hospital of North Norway , Tromsø , Norway.
Abstract
BACKGROUND:Many patients with limited disease small cell lung cancer (LD SCLC) suffer from comorbidity. Not all patients with comorbidity are offered standard treatment, though there is little evidence for such a policy. The aim of this study was to investigate whether patients with comorbidity had inferior outcomes in a LD SCLC cohort. MATERIAL AND METHODS: We analyzed patients from a randomized study comparing two three-week schedules of thoracic radiotherapy (TRT) plus standard chemotherapy in LD SCLC. Patients were to receive four courses of cisplatin/etoposide and TRT of 45 Gy/30 fractions (twice daily) or 42 Gy/15 fractions (once daily). Responders received prophylactic cranial irradiation (PCI). Comorbidity was assessed using the Charlson Comorbidity Index (CCI), which rates conditions with increased one-year mortality. RESULTS:In total 157 patients were enrolled between May 2005 and January 2011. Median age was 63 years, 52% were men, 16% had performance status 2, and 72% stage III disease. Forty percent had no comorbidity; 34% had CCI-score 1; 15% CCI 2; and 11% CCI 3-5. There were no significant differences in completion rates of chemotherapy, TRT or PCI across CCI-scores; or any significant differences in the frequency of grade 3-5 toxicity (p = 0.49), treatment-related deaths (p = 0.36), response rates (p = 0.20), progression-free survival (p = 0.18) or overall survival (p = 0.09) between the CCI categories. CONCLUSION: Patients with comorbidity completed and tolerated chemo-radiotherapy as well as other patients. There were no significant differences in response rates, progression-free survival or overall survival - suggesting that comorbidity alone is not a reason to withhold standard therapy in LD SCLC.
RCT Entities:
BACKGROUND: Many patients with limited disease small cell lung cancer (LD SCLC) suffer from comorbidity. Not all patients with comorbidity are offered standard treatment, though there is little evidence for such a policy. The aim of this study was to investigate whether patients with comorbidity had inferior outcomes in a LD SCLC cohort. MATERIAL AND METHODS: We analyzed patients from a randomized study comparing two three-week schedules of thoracic radiotherapy (TRT) plus standard chemotherapy in LD SCLC. Patients were to receive four courses of cisplatin/etoposide and TRT of 45 Gy/30 fractions (twice daily) or 42 Gy/15 fractions (once daily). Responders received prophylactic cranial irradiation (PCI). Comorbidity was assessed using the Charlson Comorbidity Index (CCI), which rates conditions with increased one-year mortality. RESULTS: In total 157 patients were enrolled between May 2005 and January 2011. Median age was 63 years, 52% were men, 16% had performance status 2, and 72% stage III disease. Forty percent had no comorbidity; 34% had CCI-score 1; 15% CCI 2; and 11% CCI 3-5. There were no significant differences in completion rates of chemotherapy, TRT or PCI across CCI-scores; or any significant differences in the frequency of grade 3-5 toxicity (p = 0.49), treatment-related deaths (p = 0.36), response rates (p = 0.20), progression-free survival (p = 0.18) or overall survival (p = 0.09) between the CCI categories. CONCLUSION:Patients with comorbidity completed and tolerated chemo-radiotherapy as well as other patients. There were no significant differences in response rates, progression-free survival or overall survival - suggesting that comorbidity alone is not a reason to withhold standard therapy in LD SCLC.
Authors: Arthur Jochems; Issam El-Naqa; Marc Kessler; Charles S Mayo; Shruti Jolly; Martha Matuszak; Corinne Faivre-Finn; Gareth Price; Lois Holloway; Shalini Vinod; Matthew Field; Mohamed Samir Barakat; David Thwaites; Dirk de Ruysscher; Andre Dekker; Philippe Lambin Journal: Acta Oncol Date: 2017-10-14 Impact factor: 4.089
Authors: Geoffrey Liu; Grainne M O'Kane; Ali Vedadi; Sharara Shakik; M Catherine Brown; Benjamin H Lok; Frances A Shepherd; Natasha B Leighl; Adrian Sacher; Penelope A Bradbury; Wei Xu Journal: Qual Life Res Date: 2020-08-26 Impact factor: 3.440