| Objective:The study of efficacy,toxicity and tolerance of elderly patients with advanced non-small cell lung cancer (NSCLC) was provide help for them on the treatment.Methods:A retrospective study of 65 cases of patients with NSCLC,aging≥65 years old,stagingⅢB orⅣand receiving the first-line chemotherapy in Jilin Province People's Hospital between January 2005 and July 2009 was analyzed.All patients were diagnosed by pathology or cytology examination in our hospital, the median age of these patients was 73 years old; including forty-three males, twenty-two females; clinical stage ofⅢB in 38 cases,Ⅳin 27 cases; PS score 0 in 3 cases, score 1 in 38 cases, score 2 in 24 cases; squamous cell carcinoma in 25 cases, adenocarcinoma in 40 cases.Treatment All sixty-five patients were gived the first-line chemotherapy, including 2 cases of single agent chemotherapy,61 cases of combination chemotherapy, and 2 cases of targeted therapy. Single agent gemcitabine (1000mg/m2 d1 and d8 Jiangsu Howson)in 2 cases; combination chemotherapy:cisplatin-based combination chemotherapy in 56 cases;gemcitabine (1000mg/m2 d1 and d8 Jiangsu Howson)+cisplatin (50-80mg/m2 d1 and d8 Jiangsu Howson) in 23 cases; Vinorelbine (25 mg/m2 d1 and d8 Jiangsu Howson)+cisplatin (50-80mg/m2 d1 and d8 Jiangsu Howson) in 9 cases; paclitaxel (135-175mg/m2 dl Beijing Fourth Ring)+cisplatin (50-80mg/m2 d1 Jiangsu Howson) in 24 cases;non-cisplatin chemotherapy in 5 cases, all of cases used gemcitabine (1000mg/m2 d1 and d8 Jiangsu Howson)+vinorelbine (25 mg/m2 d1 and d8 Jiangsu Howson). The average number of receiving first-line chemotherapy cycles was 2.9. Analysis of the efficacy and toxicity:Evaluation criteria included complete remission (CR), partial remission (PR), Stable disease (SD) and progress disease (PD), CR+PR were calculated as efficient, CR+PR+SD was calculated as disease control rate. According to the U.S. National Cancer Institute (NCI) common toxicity criteria version 3 grades the severity of adverse events.statistical analysis:Statistical analyses were performed with the use of SPSS 13.0 efficacy and adverse effections between groups was compared by the use of the 2 tests. P values less than 0.05 were considered to have statistical significance.Results:1. The analyses of the total effective rate. The total effective rate was 41.5%, The overall disease control rate was 89.2%, no significant statistical differences between cisplatin-based group and non-cisplatin combination chemotherapy group. No significant statistical differences among the three cisplatin-based chemotherapy groups.2. Toxicity Observation according to the first-line treatment the patients were divided into four subgroups:single-agent chemotherapy, cisplatin-based combination chemotherapy, non-cisplatin combination chemotherapy, targeted therapy. No significant statistical differences in toxicity were compared among the three cisplatin-based chemotherapy groups. Non-cisplatin combination chemotherapy, single agent chemotherapy and targeted therapy groups were not statistical analysis because of only several cases in each group. All groups had no chemotherapy-related death.3. Toxicity and efficacy analysis in elderly patients'subgroup. Elderly patients in the combination group (including cisplatin-based and non-cisplatin combination chemotherapy groups) were classified as the two subgroups by age, more than 65 and less than 75 years old, and more than 75 years old. In the comparison of toxicity and efficacy, the hematological toxicity and gastrointestinal toxicity in more than 75 years old patients were more serious compared with more than 65 and less 75 years old patients, this was statistical significance, but all patients were able to tolerate chemotherapy, without chemotherapy-related death, while There was no significant difference in efficacy of the two age groups.4. In the comparison of pathology types and efficacy were not significant statistical difference among cisplatin-based chemotherapy with two-drug combination. Discussion:Advanced NSCLC accounts for 80% in the lung cancer patients, chemotherapy was the main treatment. Currently cisplatin-based chemotherapy with two drug combination was serviced as standard the first-line treatment for advanced NSCLC, while the elderly patients as a special group, drug toxicity and organ function and life quality score need to be considered for them.The analysis shows that most elderly people can be safe with the chemotherapy and chemotherapy toxicity without chemotherapy-related death. The small size of the sample within single agent chemotherapy group, targeted therapy group and the non-cisplatin combination chemotherapy groups may be related with the selection of cases. The study showed most patients in good general condition chose cisplatin based chemotherapy, and the patients in poor general condition usually chose non-cisplatin combination chemotherapy or single agent chemotherapy. We analyzed and compared the efficacy between≥75 years old group and≥65 and＜75 years old group. There was no statistically significance in the short-term efficiency.Only hematological toxicity and gastrointestinal toxicity of the two groups was statistically significance, but all patients can tolerate.So this study suggests that eldly patient is not chemotherapy contraindication, the age is not an important factor affecting the treatment of advanced NSCLC. As long as the good general state and PS score≤2, even if over 75 years, can be treated with cisplatin-based chemotherapy with two-drug combination, but doses could be reduced by One third. The total effective rate of the 65 patients was 41.5%, the disease control rate was 89.2%. The results were similar to the foreign-related reports about the treatment of lung cancer in elderly patients. About the choice of chemotherapy, a large number of literature references suggest that cisplatin-based chemotherapy with two-drug combination has the better efficacy, toxicity can be tolerated, so standard combination chemotherapy with cisplatin-based is recommended for the PS score 0-2 in elderly patients. Conclusion:Age is not a combination chemotherapy contraindication, and cisplatin-based two-drug combination chemotherapy is recommended for the lower PS score and better organ function in elderly patients. Doses could be reduced by One third. There were no significant statistical differences about efficacy and toxicity among the three chemotherapy with cisplatin-based including GP, NP, TP. |
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