A study of elderly patients with limited-stage small-cell lung cancer after combined chemoradiotherapy

In this study, we evaluated the effect of chemotherapy (CT) and thoracic radiotherapy (RT) integration and the timing of RT on survival of elderly patients with limited-stage small-cell lung cancer. Eighty patients were retrospectively analyzed. All the patients revived thoracic RT and 70 patients received ≥2 cycles of CT. Twenty-two patients received RT sequentially to CT, 19 with RT consolidated with CT, and 29 with RT concurrent with CT. Early chest irradiation was defined as beginning RT after 1-3 cycles of CT (n = 44), and late chest irradiation was defined as occurring after ≥4 cycles of CT (n = 26). Twenty-six patients (32.5%) achieved complete response, 37 (46.2%) partial response, 10 (12.5%) stable disease, and 7 (8.7%) progressive disease. The median survival time for all patients was 19 months. The 1-, 2-, and 3-year overall survival (OS) rates were 68.9%, 41.3%, and 31.7%, respectively. In univariate analyses, the volume of the primary tumor, CT, treatment modality, timing of RT, target volume, and RT dose were significantly associated with OS. At 3 years, concomitant chemoradiotherapy was superior to consolidated and sequential chemoradiotherapy (40.0% vs. 36.9% vs. 40.0%, respectively). The rate of OS at 3 years was 37.1% for patients receiving early-RT and 27.8% for those receiving late-RT (P = 0.006). Multivariate analysis showed that CT and RT dose were independent factors influencing OS. Concurrent chemoradiotherapy resulted in a high survival rate. A radiation dose-response relationship was observed, and a dose of at least 60-Gy daily radiation demonstrated improved survival.