Compliance and outcome of elderly patients treated in the Concurrent ONce daily VErsus twice-daily RadioTherapy (CONVERT) trial

INTRODUCTION: There is a lack of data on the efficacy and safety of concurrent chemo-radiotherapy in elderly, limited-stage, patients with small cell lung cancer.

METHODS: We compared outcomes of patients aged ≥70 years vs. younger patients within the Concurrent ONce-daily VErsus twice-daily RadioTherapy (CONVERT) trial. Patients were randomised to receive 45Gy/30 twice-daily fractions/3 weeks or 66Gy/33 once-daily fractions/6.5 weeks concurrently with platinum-based chemotherapy. Overall survival (OS) and progression free survival (PFS) were evaluated using Kaplan-Meier methodology and Cox proportional hazards regression.

RESULTS: Of 547 patients randomised between April 2008-November 2013, 57 did not receive protocol treatment and were excluded. Of the 490 patients included, 67 (14%) were aged ≥70 years (median age: 73 years; range 70-82). Fewer older patients received the optimal number of radiotherapy fractions (73% vs. 85%; p=0.03); however, chemotherapy compliance was similar in both groups (p=0.24). Neutropenia grade 3/4 occurred more frequently in the elderly (84% vs. 70%; p=0.02) but rates of neutropenic sepsis (4% vs. 7%; p=0.07) and death (3% vs. 1.4%; p=0.67) were similar in both groups. With a median follow-up of 46 months; median survival in the elderly vs. younger groups was 29 (95% confidence interval (CI) 21-39) vs. 30 months (95% CI 26-35) respectively; (hazard ratio (HR) 1.15, 95% CI 0.84-1.59; p=0.38). Median time to progression in the elderly vs. younger groups was 18 (95% CI 13-31) vs. 16 months (95% CI 14-19) respectively; (HR 1.04, 95% CI 0.76-1.41; p=0.81).

CONCLUSIONS: Concurrent chemo-radiotherapy with modern radiotherapy techniques should be a treatment option for fit, older patients.