More than half of patients with stage III lung cancer not eligible for concurrent chemoradiation:

1
More than half of patients with stage III lung
cancer not eligible for concurrent
chemoradiation Data of the Maastricht Cancer
Registry, 2002-2005
A. Botterweck1, D. De Ruysscher2, M. Dirx1, M.
Pijls-Johannesma3, R. Wanders3, M. Hochstenbag4,
A. Dingemans4, G. Bootsma5, W. Geraedts6, J.
Simons8, C. Pitz7, P. Lambin1 1Maastricht Cancer
Registry, Comprehensive Cancer Centre Limburg
(IKL) 2Department of Radiation Oncology (Maastro
Clinic), GROW Research Institute, University
Medical Center Maastricht 3 Maastro Clinic,
Maastricht 4Department of Pulmonology,
University Medical Center Maastricht 5Department
of Pulmonology, Atrium Medical Center, Heerlen
6Department of Lung Diseases, Maasland Hospital,
Sittard 7Department of Lung Diseases, Laurentius
Hospital, Roermond 8Department of Lung Diseases,
Sint Jans Gasthuis, Weert, The Netherlands.

• Introduction
• Patients with locally advanced (stage III) lung
  cancer achieve better survival receiving
  concurrent chemoradiation in stead of the
  sequential approach.
• However, concurrent chemoradiation is given to
  patients with no or minimal comorbidity due to
  higher toxicity of the therapy.
• Comorbidity is frequently observed in smokers
  and elderly patients both at high risk for lung
  cancer.

• Results
• 711 patients had stage III NSCLC (81) or SCLC
  (19) 545 (76,7) were lt 75 years.
• Of the 526 patients lt 75 years with a known
  comorbidity status, comorbidities were as
  follows 278 (52,9) 0, 188 (35,7) 1, and 56
  (11,4) 2 or more (figure 1).
• A large proportion of comorbidities were lung
  diseases and cardiovascular diseases.
• Of the whole patient group, 59 were ineligible
  for concurrent chemoradiation (figure 2).
• The percentages patients ineligible for
  concurrent chemoradiation by age group were 34
  (0-59 years), 50 (60-69 years), 59 (70-74
  years) and 100 (75).

Aim To evaluate what proportion of patients with
locally advanced lung cancer is suitable for
concurrent chemoradiation.

• Methods
• All stage III patients with NSCLC and SCLC
  from the Maastricht Cancer Registry (MCR), the
  Netherlands (2002-2005) were included.
• The MCR is a population-based cancer registry.
• Comorbidity, a regular item in de MCR, was
  scored prospectively using a slightly adapted
  version of the Charlson comorbidity index.
• Patients with one or more important comorbidity
  (table 1) or 75 years and over were regarded as
  ineligible for concurrent chemoradiation.

Figure 2 Number of lung cancer patients stage
III versus number of patients eligible for
concurrent chemoradiation, MCR 2002-2005
All stage III patients

• Table 1 Scored important comorbidity in this
  study
• Chronic Obstructive Pulmonary Disease (COPD)
• Cardiovascular disease myocardial infarction,
  cardiac insufficiency, angina pectoris, CABG
  (coronary artery bypass graft)
• Peripheral arterial disease intermittent
  claudication, abdominal aneurysm, surgical
  intervention
• Cerebrovascular diseases (cerebrovascular
  accident, hemiplegia)
• Other
• rheumatoid arthritis (only severe)
• kidney diseases glomerulonephritis,
  pyelonephritis
• gastrointestinal stomach ulcer resection,
  colitis
• lliver diseases cirrhosis, hepatitis
• dementia
• chronic infections
• In our analyses, other malignancies,
  hypertension, diabetes mellitus and some
  autoimmune diseases (sarcoidosis, Wegener's
  disease, systemic lupus erythematosis) were
  regarded as non-severe comorbidities.

Eligible for concurrent therapy

• Discussion
• This is the first population based study that
  investigated the proportion of lung cancer
  patients eligible for concurrent therapy which
  gives more realistic figures of eligibility
  patients in trials are younger and healthier.
• The a priori criterion of one or more important
  comorbidity may be too strict patients with COPD
  or cardiovascular diseases may still be eligible
  for concurrent chemoradiation.
• Performance status (PS) gt2 as criterion for
  ineligibility was not available however, PS and
  comorbidity are strongly related.

Figure 1 Number of comorbidities per age category
Number of patients
Number of co morbidities

• Conclusion
• More than half of patients with stage III lung
  cancer were not eligible for concurrent
  chemoradiation.
• Less toxic alternatives are needed for these
  patients.

Age categories (years)
NSCLC non small cell lung cancer SCLC small
cell lung cancer
Correspondence to Dr D.K.M. De Ruysscher,
Department of Radiation Oncology (Maastro
Clinic) University Medical Center Maastricht,
Grow Research Institute, Dr Tanslaan 12, 6229
ET Maastricht, The Netherlands Tel
31-88-445-57-00, Fax [phone] E-mail
dirk.deruysscher_at_maastro.nl
e-publication ahead of print D. De Ruysscher, A.
Botterweck, M. Dirx, M. Pijls-Johannesma, R.
Wanders, M. Hochstenbag, A. Dingemans, G.
Bootsma, W, Geraedts, J. Simons, C. Pitz, and P.
LambinEligibility for concurrent chemotherapy
and radiotherapy of locally advanced lung cancer
patients a prospective, population-based
studyAnn. Oncol doi10.1093/annc/mdn559