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KMID : 0882420080750020162
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Korean Journal of Medicine
2008 Volume.75 No. 2 p.162 ~ p.168
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Treatment of lung cancer in the elderly
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Lee Jeong-Eun
Kim Sun-Young
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Abstract
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Elderly patients frequently experience progressive decline of organ function and multiple comorbidities, which need to be considered when choosing therapy. In early non-small cell lung cancer (NSCLC), surgical resection is the mainstay of
curative treatment with a favorable survival even in the elderly. But postoperative mortality following pneumonectomy is
high, and this operation should only be performed in selected patients with acceptable heart-lung function. In locally
advanced NSCLC, combined chemoradiotherapy is effective in younger patients and in older patients, despite increased
toxicity. Platinum based combination chemotherapy is similar in fit older and younger patients with increased but
acceptable toxicity for elderly patients. Single agent chemotherapy with a third generation agent (gemcitabine, vinorelbine,
taxanes) could be considered a reasonable treatment option for elderly patients. Target therapy with pemetrexed, gefitinib
and erlotinib is feasible to treat elderly patients. In limited disease small cell lung cancer (SCLC), concurrent
chemoradiotherapy seem to be superior to sequential approach and yield higher survival despite increased toxicity. In case of elderly patients, it is not supported by prospective trials. Prophylactic cranial irradiation is the standard treatment in
limited disease SCLC except patients with cognitive dysfunction. In extensive disease SCLC, platinum based
chemotherapy is standard treatment. Many studies demonstrate that the elderly patient with a good performance status
(PS) can tolerate chemotherapy that has similar toxicity and benefits as nonelderly patients. But, the assessment of
comorbidity and the evaluation of functional status are prerequisite for benefit in elderly patients. It can be useful, not only for providing important information to the patients, but also for the correct choice of treatment. (Korean J Med 75:162-168, 2008)
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KEYWORD
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Elderly, Lung cancer, Treatment
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