Updated January 2014
Analysis of data on chemotherapy delivery, thoracic irradiation delivery, and treatment efficacy indicates that patient age (at least up to age 75) does not influence survival of good performance status patients with limited small cell lung cancer (Siu, 1996). Potentially curative combined modality treatment should not be withheld on the basis of age. However, because of smoking induced and other co-morbid illness, many elderly patients with SCLC tolerate standard regimens poorly.
Limited SCLC patients with poor performance status or significant co-morbid medical illness may not tolerate four cycles of EP. For patients with impaired renal function (creatinine clearance less than 60 cc’s per minute), carboplatin may be substituted for cisplatin. Substitution of carboplatin for cisplatin in the EP regimen has less gastrointestinal and renal toxicity but the regimen is myelosuppressive.
Even more frail or very elderly (> 75 years) patients with limited SCLC are problematic as their prognosis is poor if they receive thoracic irradiation only and low intensity chemotherapy does not have curative potential. Integrated chemoradiation with four cycles of chemotherapy may be poorly tolerated with risk of severe and life-threatening toxicity. A pilot study from the BCCA prospectively investigated abbreviated chemotherapy with only two cycles of chemotherapy plus thoracic irradiation (Murray, 1998). In a cohort of 55 patients, 5-year survival was 18% suggesting that the first two cycles of chemotherapy are the most important for generating a chance of long-term survival. This model of abbreviated chemotherapy (two cycles) plus thoracic irradiation is suitable for very frail patients with limited SCLC and those that have unacceptable toxicity from early chemoradiation of standard protocols.
Siu LL, Shepherd FA, Murray N, et al. The influence of age on the treatment of limited stage small-cell lung cancer. J Clin Oncol 1996;14:821-828.
Murray N, Grafton C, Shah A, et al. Abbreviated treatment for elderly, infirm, or non-compliant patients with limited-stage small-cell lung cancer. J Clin Oncol 16:3323-3328, 1998