1. Background
Platinum-based chemoradiotherapy (CRT) and adjuvant anti-PD-L1 immunotherapy is recommended for suitable patients with stage III NSCLC. This regimen can cause significant toxicities. As such, it is not suitable for some less fit patients. Whether age should be a barrier is not clear.
2. Aims
We aimed to establish survival outcomes for our patients who were treated with CRT and immunotherapy for stage III NSCLC.
3. Methods
The AURORA database is a prospectively maintained database for all patients with lung cancer treated at our centre. We used this database to review diagnostic, treatment, and outcome data for all 265 patients with stage III disease treated with CRT over a 10 year period, focusing on age as a potential prognostic factor. Overall survival (OS) was analysed using Kaplan Meier plots. Older patients (≥ 70 years at diagnosis) were compared with younger patients (< 70 years) using Cox proportional hazards regression.
4. Results
Median follow-up was 5.4 years. 168 (63%) were < 70 and 97 (37%) were ≥ 70. Median overall survival (OS) was 2.0 years for those < 70 years (95% CI 1.5, 2.7) and 2.8 (1.5, 3.3) for those ≥ 70. Age was not associated with overall survival (Hazard ratio 1.16 for those ≥70, 95% CI 0.86, 1.55). In univariable analysis, the hazard ratio (HR) was 1.07 (95% CI; 0.93, 1.23), p=0.35, per 10 years increase in age at diagnosis. On multivariable analysis, adjusted for age, sex, baseline weight loss, ECOG performance status, smoking status, and whether the full course of CRT was completed, the HR was 1.02 (95% CI: 0.88-1.19), p=0.80.
5. Conclusion
Older age was not associated with worse OS in patients with stage III NSCLC treated with definitive CRT. CRT may reasonably be given to older patients who are otherwise fit.