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S39
daily fractions) but there is a paucity of efficacy and toxicity
data in the very elderly age group especially with a hypo
fractioned regieme.
Objectives:
To assess the overall survival of patients
with NSCLC over the age of 80, treated with radical hypo
fractionated radiotherapy. The tolerability and toxicity of
treatment was also analysed.
Methods:
Between 2007-2013, 260 consecutive patients
treated radically with radiotherapy over the age of 80 with
stage 1-3 NSCLC were identified. Retrospective analysis
of electronic records was performed. Demographic data,
histological diagnosis, stage, performance status, acute
toxicity (CTCAE v4), completion of treatment and overall
survival were collected. Radiotherapy parameters including
PTV (planning target volume) and V20 were available for 149
patients.
Results:
Median overall survival was 18.2 months. The
mean age of the patients was 84 years (range 80-94).
Table (abstract P004)
Gender
Male
149 (57%)
Female
111 (43%)
Staging
Stage 1
121 (47%)
Stage 2
49 (19%)
Stage 3
71 (27%)
Unrecorded
19 (7%)
Histological confirmation
149 (57%)
Performance status
0-1
104 (40%)
2-3
95 (37%)
Unknown
61 (23%)
Treatment was well tolerated, 98% of patients completed
radiotherapy – discontinuation was due to intercurrent
illness or increase in volume treated on cone beam imaging.
Ninety-day mortality was 1.6%. The most common acute
grade 2 toxicity was oesophagitis in 97 (38%) patients. One
patient experienced grade 3 pneumonitis with no other grade
3 toxicity. 17 (23%) of patients with stage 3 disease received
sequential chemoradiotherapy; none received concurrent
chemoradiotherapy.
There was no significant in difference in overall survival
between patients according to pretreatment performance status
or stage, although there was a trend towards improved survival
in stage 1 patients. There was a significant difference in overall
survival when comparing radiotherapy volume.Median PTVwas
309cc. The median overall survival was 26.9 months in patients
with a PTV <300cc vs 11 months
=300cc (p<0.05.)
Conclusion:
This hypo fractionated regimen is the most
commonly used in the UK. This is the largest series to date
evaluating unselected consecutively treated very elderly
patients. It demonstrates that their survival is in line with
previously published data [2] and it is well tolerated, although
low grade toxicity was likely to be underreported due to
retrospective data collection. A large number of patients in
the cohort had stage 1 disease and the increase in access to
SABR (stereotactic ablative body radiotherapy) may benefit
similar patients in the future. The very elderly should not be
excluded from radical radiotherapy on basis of age alone but
patient selection remains vital.
References:
[1] Cancer Research UK
http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-
type/lung-cancer/incidence#heading-One (accessed 8 June
2016)
[2] P. Wisnivesky, E. Halm, M. Bonomi, C. Powell, E. Bagiella.
Effectiveness of radiation therapy for elderly patients with
unresected stage I and II non-small cell lung cancer. Am J
Respir Crit Care Med, 181 (2010), pp. 265–269
Disclosure of interest:
None declared
Keywords:
Elderly, hypofractionated, lung cancer, NSCLC,
radiotherapy
P005
THE BENEFIT AND TOLERABILITY OF ADJUVANT
CHEMOTHERAPY IN ELDERLY STAGE III COLON CANCER
PATIENTS: A 3 YEAR RETROSPECTIVE AUDIT
A. Srivastava
1,
*, M. B. Jameson
1
, H.-S. Lin
1
, D. Turner
1
1
Medical Oncology, Waikato Hospital, Hamilton, New Zealand
Introduction:
Colorectal cancer incidence in New Zealand
is among the highest in the world. It is the third commonest
malignancy in NZ after prostate and breast cancer, though its
mortality is as high as that of the latter two cancers combined.
Objectives:
The benefit of adding oxaliplatin to fluoro-
pyrimidine in patients
70 years is controversial. This
retrospect audit investigated usage, benefit and tolerability of
adjuvant chemotherapy for colon cancer with increasing age.
Methods:
Patients aged
60 years with stage III colon cancer
referred for adjuvant chemotherapybetween 2010-2012 were
identified froma tertiary hospitaloncology database. Data
were collected on demographics, chemotherapy received,
completion rates, toxicities, relapse and survival.
Results:
95 eligible patients were identified, 50 over 70
years old (median 76 years), 45 aged 60 to 70 years (median
66), 56% male, 82% NZ European and 5% Maori. There was no
significant difference in Charlson comorbidity index, ECOG
Performance status or TNM staging. Older patients were less
likely (p=0.0017) to receive adjuvant chemotherapy (76% and
91% of those aged
70 and 60-70 years respectively), especially
oxaliplatin containing regimens (14% and 47% of older and
younger groups, respectively). Similar proportions (~75%) in
each group completed
80% of planned chemotherapy doses
with no significant difference in early discontinuation due to
toxicities. Survival was poor in the older group (HR=2.90, 95%
CI1.40-5.47), including who received chemotherapy (HR=3.22,
95% CI 1.42-6.88) but there was no significant difference in
relapse free survival between older and younger patients.
Conclusion:
Adjuvant chemotherapy was commonly
offered to older adults with stage III colon cancer, although
oxaliplatin was largely restricted to younger patients. While
relapse free survival was similar between age groups and
chemotherapy types, older patients had poorer survival
despite adjuvant chemotherapy.
Disclosure of interest:
None declared
Keywords:
Adjuvant chemotherapy, colon cancer, elderly,
survival, tolerability