文章：

从放射肿瘤学视角探讨老年局部非小细胞肺癌患者多模式治疗结局：特别关注低剂量顺铂方案

Outcomes of Multimodal Treatment in Elderly Patients with Localized Non-Small Lung Cancer from a Radiation Oncology Point of View: Special Focus on Low-Dose Cisplatin

原文发布日期：11 January 2024

DOI: 10.3390/cancers16020327

类型: Article

开放获取: 是

英文摘要：

Identification of the optimal treatment strategy is challenging in elderly with localized non-small cell lung cancer (NSCLC). Concurrent chemotherapy with low-dose cisplatin represents an option for elderly. Outcomes (1) in elderly (≥70 years,n= 158) vs. younger patients (n= 188) and (2), independently of age, in definitive radiochemotherapy, with low-dose cisplatin (n= 125) vs. cisplatin/vinorelbine (n= 76) were studied. Elderly included more males, had a lower Karnofsky index, more comorbidities, and lower stages. Low-dose cisplatin patients (vs. cisplatin/vinorelbine) had higher age, more comorbidities, and lower stages. We observed reduced dermatitis and dysphagia and increased anemia and thrombocytopenia in elderly vs. younger patients, without increased ≥grade 3 toxicities. Low-dose cisplatin was less toxic than cisplatin/vinorelbine. Survival outcomes were lower in elderly vs. younger and comparable between low-dose cisplatin and cisplatin/vinorelbine. In elderly, gender, Karnofsky index, stage, and multimodal treatment (including additional surgery/systemic therapy) were identified as prognostic factors. In conclusion, we found evidence for an acceptable toxicity profile and the need for improvement of outcomes in elderly with localized NSCLC. Multimodal strategies (including additional surgery/systemic treatment) showed favorable outcomes and should be reasonably considered in elderly who are deemed fit enough. Low-dose cisplatin should be discussed on an individual basis due to favorable toxicity and outcomes.

摘要翻译： 

对于老年局限性非小细胞肺癌患者，确定最佳治疗策略具有挑战性。低剂量顺铂同步化疗是老年患者的一种选择。本研究分析了（1）老年患者（≥70岁，n=158）与年轻患者（n=188）的结局，以及（2）不考虑年龄因素，根治性放化疗中低剂量顺铂方案（n=125）与顺铂/长春瑞滨方案（n=76）的结局。老年组男性比例更高、卡氏评分更低、合并症更多、分期更早。与顺铂/长春瑞滨组相比，低剂量顺铂组患者年龄更高、合并症更多、分期更早。研究发现，与年轻患者相比，老年患者皮炎和吞咽困难发生率降低，贫血和血小板减少发生率升高，但≥3级毒性反应未见增加。低剂量顺铂方案的毒性低于顺铂/长春瑞滨方案。老年患者生存结局低于年轻患者，而低剂量顺铂与顺铂/长春瑞滨方案的生存结局相当。在老年患者中，性别、卡氏评分、分期及多模式治疗（包括额外手术/全身治疗）被确定为预后因素。综上所述，本研究表明老年局限性非小细胞肺癌患者具有可接受的毒性特征，但其治疗结局仍需改善。多模式策略（包括额外手术/全身治疗）显示出良好疗效，对于身体状况允许的老年患者应予以合理考虑。鉴于其良好的毒性和疗效特征，低剂量顺铂方案应根据个体情况酌情选用。

原文链接：

Outcomes of Multimodal Treatment in Elderly Patients with Localized Non-Small Lung Cancer from a Radiation Oncology Point of View: Special Focus on Low-Dose Cisplatin