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Summary: Age doesn't have to be a barrier to getting aggressive treatment for small cell lung cancer, Mayo Clinic researchers report in the journal Cancer. A study of people treated with both chemotherapy and radiation found no survival differences for elderly patients (those 70 or older) compared to younger patients, though older patients did suffer more side effects.

Why it's important: Adding radiation to chemotherapy has been shown to improve survival for people with small cell lung cancer compared to chemotherapy alone. But the combination treatment can be difficult to tolerate. Because about half of lung cancer patients are elderly, it's important to learn whether this aggressive therapy can help them as much as it does younger patients.

What's already known: Several previous studies have looked at combination therapy for lung cancer and found that elderly patients generally do just as well as younger ones in terms of survival. However, the findings about side effects have not been consistent; some studies saw few differences between older and younger patients, while others found that elderly patients had more severe problems associated with treatment.

How this study was done: The researchers studied 263 people (54 of them were 70 or older) with limited-stage small cell lung cancer. All the patients received chemotherapy with etoposide and cisplatin, and radiation either once or twice a day. The researchers compared how long it took for the tumors to start growing again, survival, and the severity of side effects among younger and older patients.

What was found: Age was not a factor in how quickly the tumors returned; similar numbers of patients in both age groups were still cancer-free 2 and 5 years after treatment. The differences in survival were a little greater, but were not statistically significant. Two years after treatment, 48% of younger patients and 33% of older patients were still alive. Five years after treatment, 22% of younger patients and 17% of older patients were still alive.

Patients in both age groups experienced similar rates of severe side effects, including nausea, vomiting, irritation of the esophagus, and low white blood cell and platelet counts. Elderly patients, however, had more cases of pneumonitis, a breathing problem that requires treatment with a ventilator or continuous oxygen. Six percent of patients 70 and older developed this side effect, but none of the younger patients did. Three elderly patients died of this complication. One younger patient died from an infection.

Study strengths and limitations: All the patients in the study received similar treatments, so the researchers were able to determine the effects of age on survival and side effects. However, they note that elderly patients who are chosen for clinical trials are usually in fairly good health (aside from their cancer). Elderly people who have other illnesses may not do as well with aggressive treatment. It's also not clear how even older people -- in their 80s, say -- would respond to this treatment, because the oldest person in this trial was 81 when it ended.

The bottom line: Elderly lung cancer patients who are otherwise in good health should be offered combination treatment with chemotherapy and radiation. But the researchers say treatments are best given within a clinical trial so patients can be carefully monitored for dangerous side effects. They say more studies are needed to find ways to reduce side effects in older people.

Citation: "Results of combined-modality therapy for limited-stage small cell lung carcinoma in the elderly." Published in Cancer (Vol. 103, No. 11: 2349 - 2354). First author: Steven Schild, MD, of the Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona.