Treatment of limited-stage disease in older patients: the role of thoracic radiotherapy and prophylactic cranial irradiation

Elderly patients should neither be undertreated nor overtreated with RT
or CTRT. Treatment selection should not be made on the basis of chronological age and should take into account performance status, stage, comorbidities, nutritional status, and patients’ preference. The benefits of concurrent CTRT have to be balanced against the risks of radiation esophagitis and pneumonitis which are more likely to lead to hospitalization, malnutrition, and deterioration of QoL in the elderly compared to their younger counterparts. Future studies in SCLC including elderly patients are urgently needed with emphasis on toxicity, QoL, and efficacy. The use of geriatric assessments may help to de fi ne groups of patients more likely to benefitfrom aggressive treatments such as concurrent CTRT and may also enable more robust stratification of elderly patients in prospective studies. Furthermore, advances in RT planning and delivery, such as omitting elective nodal irradiation, 4-D conformal RT planning, intensity-modulated radiotherapy (IMRT), and image-guided radiotherapy (IGRT), are likely to widen the therapeutic window, and the resulting reduction in toxicity should make future RT more tolerable for elderly patients.