| Objective: To observe the short term effect and toxic reaction of concurrent chemoradiotherapy and radiotherapy alone for advanced non-small cell lung cancer(NSCLC) in elderly, to evaluate the quality of life(QOL) of the elderly, in order to provide material for the treatment of lung cancer in elderly.Methods: From November 2008 to December 2009, 42 patients , which aged over 65 years old, with non-small cell lung cancer were eligible for the analysis. The median age was 70 years old(range 65 to 84 years). There are 22 patients accepted concurrent chemo-radiotherapy(CT-RT) , and 20 patients were accepted radiotherapy(RT)alone. In the cases, there are 31 males , 11 females; 22 patients with squamous carcinoma, 18 with adenocarcinoma , 2 with adenosquamous carcinoma; 23 patients were central type and 19 patients were peripheral type ; 18 patients were right lung and 24 patients were left lung;18 patients with stageⅢa and 14 patients with stageⅢb,and 10 patients with stageⅣ. The radiation therapy used image-guided three dimensional -conformal radiotherapy, the dose was delivered in 2Gy per fraction , 5 fractions per week , to a total dose of 50～66Gy . Concurrent chemotherapy formula: (1) paclitaxel liposome (lipusu) 135～175 mg/m2 by intravenous infusion (iv) for >3 h on day 1, combined with cisplatin (DDP) 20mg infused on day 1～5, repeated every 21 days. 2) paclitaxel liposome was given at 45mg/m2 once a week with 6 weeks. Consolidation chemotherapy with the same schema were given by 2～4 cycles after concurrent chemoradiotherapy. Dexamethasone 5mg,Cimetidine 400mg and Diphenhydramine 50mg were administered intravenously 30min before Lipusu in preventing hyper - sensitivity reactions. The short time effects , toxicity and quality of life were observed during and after the treatment.Results: All of 42 patients completed the three dimensional-conformal radiotherapy on schedule with total radiation time of 40-50 days. There have 9 patients received weekly chemotherapy, 2 patients finished 5 week chemotherapy,7 patients received 6 week chemotherapy,5 patients received another 2 cycles of consolidation chemotherapy. 7 patients received 4 cycles of chemotherapy, 2 patients received 3 cycles of chemotherapy , 2 patients received 2 cycles of chemotherapy and 2 patients received only 1 cycle of chemotherapy.The overall response rates for CT-RT group and RT group were 59.09% and 40% respectively and their complete response rates were 9.09% and 5.0% respectively. The difference between the overall response rates was not statistically significant in both groups (P>0.05). The toxicity are maily radiation esophagitis , radiation pneumonitis and leucocytopenia. The incidence rate of side effect in the RT group were 60%(12/20) , 30% (6/20) , 60%(12/20), and 90.91%(20/22), 86.36%(19/22), 45.45%(10/22) in CT-RT group. 3 patients ( 13.6%) have minor reactions (e.g. flushing) of 22 patients. gastrointestinal reaction mainly occurred in CT-RT group.There are only 3 patients having hepatic and renal toxicity during and after the treatment. They all can tolerate through the expectant treatment.The incidence rate of radiation esophagitis and radiation pneumonitis in CT-RT group is higher than the RT group, but the difference was not statistically significant in both groups (P>0.05) . However , there was significant difference between their blood toxicity (P<0.05) . The quality of life scores of post-treatment was lower than pre-treatment in the two groups;and was statistically significant in both groups (P<0.05) . The main aspect of QOL are the cancer-related fatigue , and was statistically significant after treatment in both groups . The short response rate of weekly chemotherapy and three-week chemotherapy are 55.56% and 61.54% .The toxicity of weekly chemotherapy is lower than three-week chemotherapy, there was not statistically significant in both groups.Conclusion: 1. For the aged patients of advanced non-small cell lung cancer, The short effect rate in CT-RT group is higher than the RT group , but the difference was not statistically significant in both groups , the concurrent chemo -radiotherapy is not superior to the radiotherapy alone. 2. The toxic reaction in concurrent chemoradiotherapy is more serious than radiotherapy alone , especially in the leucocytopenia , radiation esophagitis and radiation pneumonitis . 3. Image-guided radiotherapy combined with weekly Paclitaxel liposome has the better effect and low toxicity, it is a good choice for elderly patients with advanced non- small cell lung cancer. 4. Medical staff should pay attention to the cancer-related fatigue of the elderly patients. 5. The future effect and toxicity of this study deserve futher observation.
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