The Dutch Lung Cancer Audit-Radiotherapy (Dlca-R): Real-World Data On Elderly Stage Iii Non-Small Cell Lung Cancer Treated With Definitive Chemoradiation

The Dutch Lung Cancer Audit-Radiotherapy (DLCA-R) is a national lung cancer registration that started in 2013 for patients treated with radical or curative intent radiotherapy. For elderly patients with locally advanced non-small cell lung cancer (NSCLC), real-world data is essential to be able to balance treatment toxicity and treatment outcome. The aim of this study is to analyze definitive chemoradiation (CRT) in elderly patients above 75 years of age with stage III NSCLC. All patients receiving primary thoracic radiation treatment with radical or curative intent for (primary or recurrent) stage I-IIIC lung cancer are included in this population-based study. Information is collected on patient, tumor and treatment characteristics, as well as the incidence and severity of acute toxicity. Descriptive statistics were used to compare patients ≤75 years with patients >75 years who were treated for stage III NSCLC between 2017 and 2018 with sequential chemoradiation (seqCRT) or concurrent chemoradiation (cCRT). cCRT is scored in case radiotherapy started within 30 days after the start of chemotherapy. We studied toxicity as well as mortality within three months after the end of radiotherapy. Out of all 20 Dutch departments of radiation oncology, 19 centers participate in the registry. A total of 1.523 NSCLC stage III patients were treated with CRT. 18% of these patients were >75 years (mean 79 years), and 45% of these patients was treated with cCRT while for the ≤75-year group (median 65 years) 67% was treated with cCRT. Good performance (WHO 0-1) for patients ≤75 years was 87% vs. 81% in case >75 years old. Acute 3-month toxicity (grade ≥3) was scored in 18% of the younger patients and in 15% of the older patients. The 3-month mortality rate calculated after the end of radiotherapy was 5% for the younger patients and 9% for the patients >75 years of age. Comparing concurrent vs sequential CRT showed for the younger patients grade ≥3 toxicity and mortality within three months of 18% and 4% for cCRT and 18% and 7% for seqCRT respectively. For the elderly, the grade ≥3 toxicity and mortality was 18% and 9% for cCRT and 14% and 8% for seqCRT respectively. This Dutch audit provides real-world data for stage III NSCLC patients treated with CRT. Only 44.8% of the elderly were treated with cCRT while this was 67.2% for the younger patients. The acute grade ≥3 toxicity was identical in both cCRT groups. The overall three months mortality after the end of radiotherapy was 5% in the younger patients versus 9% in the elderly.Abstract 92; Table 1Patient, tumor, and treatment characteristics of all stage III patients included in de databaseNon-Elderly n=1.300Elderly n=223p-valueAgeMean (SD)63.97 (7.7)78.71 (2.5)<0.01GenderMale53.2%70.0%<0.01WHO0-186.6%80.7%0.01Clinical stage (TNM-8)IIIA - B - C45.6 - 43.5 - 10.9%50.7 - 40.8 - 8.5%0.30ChemoradiationConcurrent67.2%44.8%<0.01Sequential22.8%47.5%Missing10.0%7.6%ToxicityGrade ≥317.5%15.2%0.16Mortality<90 days4.5%8.5%0.02 Open table in a new tab