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• W2024456979 abstract "As to non-small cell lung cancer (NSCLC), the incidence of the elderly, adenocarcinoma in histology and stage I continue to increase from year to year in Japan. The primary goal of the Patterns of Care Study (PCS) is to measure whether results and methodologies from positive clinical trials are being incorporated into practice. The purpose of this study is to analyze the impact of age on choice of treatment process for patients with stage I-III NSCLC treated with radiation therapy (RT) in Japan. A PCS, a nationwide audit survey was conducted in 78 institutions out of 556 using two-staged cluster sampling and specific information was surveyed on 909 non-small cell lung cancer patients who received thoracic RT as part of definitive or adjuvant management in 1995–1997 (PCS95-97). Second survey (PCS99-01) has started in 2002 and data from 579 NSCLC patients (67 institutions) who were treated in 1999–2001 was surveyed. As Radiation Therapy Oncology Group and the Cancer and Leukemia Group B examined groups aged 70 years or older and compared their outcomes with those of younger individuals, we used this cutoff to facilitate comparison in clinical studies. In PCS99-01, two hundreds and ninety-six (51%) patients were aged 70 years or older (elderly patients), and the number of patients increased compared with PCS95-97 (47%). Eighty-five percent of elderly patients were male, 65% were smokers, 65% had KPS 80 or better, and 70% had comorbidity (mostly cardiopulmonary) as defined in the past medical history in PCS99-01. Proportion of patients free of co-morbidities was only 30% in elderly patients and was significantly lower (p = 0.009) than the younger (59%). For elderly NSCLC, 18% of patients were clinical stage (CS) I, 13% CS II, and 69% CS III. Proportion of patients with CS IIIB (36%) was lower than that in younger patients (56%). Regarding treatment strategies, RT alone was used more frequently than combined treatment for elderly patients (52%) compared with the younger (18%), which was significant (p = 0.016). Result of clinical study was introduced in 3% in elderly patients and the proportion increased in PCS99-01 compared with PCS95-97 (0.2%). Eighty-six percent of elderly patients completed planned treatment course and the rate was higher than that of younger patients (81%). Of all patients with NSCLC, 53% received chemotherapy in addition to RT, including 37% of elderly patients and 70% of younger patients. In elderly clinical stage IIIB patients, a significant difference (p = 0.039) in the rate of usage of chemotherapy was apparent between PCS99-01 and PCS95-97 (84% vs.50%). There was a higher rate of concurrent chemotherapy in PCS99-01 compared with PCS95-97 (60% vs.48%) in elderly patients. For elderly patients without surgery, the median RT dose was 60Gy, which was the same as in younger patients. Only 8% of these patients received hyperfractionated RT. CT treatment planning was used in 55% of the elderly and 60% of the younger patients. About treatment complications, elderly patients treated with chemoradiotherapy had significantly more Grade2+ acute toxicity (37%) compared with the younger (29%). Our PCS establishes the general patterns of care for elderly patients with NSCLC treated with RT in Japan. This study enabled us monitoring the differences in the treatment strategies for elderly NSCLC patients treated by RT such as increasing the rate of chemoradiotherapy in clinical stage IIIB. Use of combined-modality therapy in locally advanced NSCLC is gradually increasing in elderly patients, but there is still wide practical variability such as patient selection. Future research should focus on ways of decreasing the toxicity in the elderly NSCLC patients" @default.
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• W2024456979 date "2004-09-01" @default.
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• W2024456979 title "The patterns of care study for non-small cell lung cancer treated with radiation therapy in Japan; analyses of age" @default.
• W2024456979 doi "https://doi.org/10.1016/j.ijrobp.2004.07.479" @default.
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