Lower Incidence of Esophagitis in the Elderly Undergoing Definitive Radiation Therapy for Lung Cancer

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Purpose/Objective(s)

The elderly population is rising in the United States. Patients older than 70 are poorly represented in the randomized clinical trials that have established the standard of care for cancer patients. We hypothesized that elderly patients undergoing definitive lung radiation might tolerate treatment differently from younger patients.

Materials/Methods

One-hundred and twenty-five patients who underwent definitive radiation therapy with or without chemotherapy for lung cancer were identified from a prospective institutional database. Biologically corrected dose volume histograms were reviewed for each patient to collect dose received by the esophagus and lungs. Esophagus doses were in terms of D2cc (dose to the most exposed 2cc) and gEUD (generalized equivalent uniform dose) using a=5, a/b=10. Lung doses were in terms of V20Gy (volume of lungs

Results

In the UM Cohort, multivariable regression models for both levels of toxicity revealed an inverse correlation between age and incidence of esophagitis, (adjusted odds ratio of 0.93 per year for both models, 95% confidence intervals (CIs) of (0.88, 0.98) and (0.87, 0.99)). The cross-validated AUC was 0.747 and 0.721, respectively. This association between age and esophagitis was validated in the MROQC registry. There was no significant association between age and lung toxicity.

Conclusion

There is a lower incidence of esophagitis with increasing age. This is a novel finding in thoracic oncology. No age dependence was noted for pulmonary toxicity. This data suggests the elderly are able to tolerate definitive thoracic radiation well and should be offered this option when clinically warranted.

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Author Disclosure: P.D. Soni: None. P.S. Boonstra: Research funding; CTI Biopharmaceuticals. M. Schipper: Advisory Role; Armune Bioscience, Hygieia Sciences. L. Bazzi: None. R.T. Dess: None. M.M. Matuszak: research funding; Varian Medical System, NIH. F.M. Kong: Honoraria; Varian Medical System. Speaker's Bureau; Varian Medical System. Travel Expenses; Varian Medical System. research funding; Varian Medical System. J.A. Hayman: None. R.K. Ten Haken: Travel Expenses; Varian Medical Systems. T.S. Lawrence: None. G.P. Kalemkerian: research funding; Merck, Oncomed, Pfizer, Astex Pharmaceuticals, GlaxoSmithKline, Millennium Health. S. Jolly: None.

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