The following is a summary of “Treatment Outcomes of Older Participants in a Randomized Trial Comparing Two Schedules of Twice-Daily Thoracic Radiotherapy in Limited-Stage SCLC,” published in the June 2023 issue of the Thoracic Oncology by Killingberg et al.

Half of patients with limited-stage SCLC (LS SCLC) are 70 or older, making up less than 20% of participants in most clinical trials. Comorbidities and decreased organ and physical function may increase treatment toxicity, and population-based studies indicate that fewer older than younger patients with LS SCLC receive standard chemoradiotherapy, even though there is limited evidence to support this practice. The researchers compared baseline characteristics, comorbidities, survival, treatment completion, toxicity, health-related quality of life, and treatment outcomes between patients older than or equal to 70 years and those younger than 70 years in an open-label, randomized phase II trial comparing twice-daily thoracic radiotherapy of 45 Gy in 30 fractions with 60 Gy in 40 fractions for LS SCLC. 

All patients received concurrent intravenous administration of cisplatin (75 mg/m²) or carboplatin (AUC 5-6 mg/ml x min) on day 1 and etoposide (100 mg/m²) on days 1-3. Randomization was performed on 170 patients who were at least 18 years old and had a performance status of 0 to 2. 53 (60 Gy: 25, 45 Gy: 28) of these patients were at least 70 years old, while 117 (60 Gy: 64, 45 Gy: 53) were younger. There were no differences between age categories in baseline characteristics, treatment completion rates, toxicity, or response rates. The mean health-related quality of life scores were comparable in the first year. 

However, in the second year, elderly patients reported a more significant decline in functional scales than younger patients. Overall survival was reduced for older patients, while progression-free survival and time to progression were comparable. Patients older than or equal to 70 tolerated concurrent twice-daily chemoradiotherapy and achieved comparable disease control to younger patients, suggesting that elderly patients should receive the same treatment as younger patients.

Source: sciencedirect.com/science/article/pii/S1556086423000163