KEY POINTS
- The retrospective cohort included 154 consecutive patients with unresectable stage III NSCLC treated between 2005 and 2015, including 48 patients >70 years and 106 aged ≤70. All patients had ECOG performance status ≤2 and were selected for curative treatment.
- Treatment consisted of 66 Gy in 24 fractions of 2.75 Gy over 5 weeks, with intravenous cisplatin 6 mg/m² before each radiotherapy fraction, for a planned cumulative cisplatin dose of 144 mg/m². 91% completed chemotherapy as planned, while all 154 patients received the prescribed radiotherapy dose.
- For the complete cohort, median survival was 33 months, with overall survival of 79%, 39% and 19% at 1, 5 and 10 years, respectively.
- Observed survival did not significantly differ by age. Five-year survival was 42% in patients >70 versus 38% in those ≤70, while median survival was 31 vs 35 months (p=0.1). At 10 years, observed survival was 10% versus 24%, respectively.
- After adjustment for expected age- and sex-specific mortality in the Dutch population, relative survival also did not significantly differ (p=0.5). Five-year relative survival was 48% in older patients versus 39% in younger patients.
- Severe toxicity was not significantly increased in the older cohort. Across all patients, grade 3-5 gastrointestinal toxicity occurred in 11%, including grade 3 oesophagitis in 8.4%; grade 3-5 respiratory/thoracic toxicity occurred in 8.4%, including grade 3 pneumonitis in 1.3%. Four patients (2.6%) experienced probable grade 5 treatment-related events.
- These results come from highly selected patients treated before consolidation immunotherapy became standard. The single-centre retrospective design, unusual daily low-dose cisplatin regimen and absence of a radiotherapy-alone comparator substantially limit extrapolation to current PACIFIC-era practice.
CLINICAL TAKEAWAY
Age over 70 alone should not automatically exclude a fit patient from concurrent chemoradiotherapy for unresectable stage III NSCLC. However, this study supports the principle rather than a specific modern regimen, because treatment predates durvalumab and the daily low-dose cisplatin schedule is not widely used.