Is There a Limit to Surgery for Patients With Lung Cancer Older Than 80 Years?: Presented at Perspectives in Lung Cancer
By Chris Berrie
TORINO, Italy -- March 16, 2011 -- If the selection for surgical therapy in patients aged older than 80 years with lung cancer is based on the disease rather than comorbidities or age, similar survival can be achieved to that seen for younger patients, according to a presentation here on March 12 at the 12th European Congress: Perspectives in Lung Cancer.
As an introduction to this problematic question of surgery for elderly patients with lung cancer, Walter Weder, MD, University Hospital Zurich, Zurich, Switzerland, initially outlined a recent patient history. This related to an 88-year-old female patient with an apparently small-cell lung cancer tumour in her lower left lobe, but no metastases. She underwent video-assisted thoracic surgery for an atypical neuroendocrine carcinoma, as a pT2pN0 lesion.
While Dr. Weder knew that this was the right decision for this patient, who made a full recovery, he noted that the evidence for such a decision relies more on such observational data in selected elderly patients, rather than on randomised studies.
The term “elderly” has obviously changed over the years, with the life expectancy of an 80-year-old living in the United States now at 8.6 years (men/women, 7.6/9.1 years). “The 5-year survival of an 80-year-old patient is 80%, and we have to take this into the balance when we are offering our treatment,” said Dr. Weder.
“Over the last years, more and more people older than 80 years get operated on,” he said. The European Society of Thoracic Surgeons (ESTS) database shows that around 3.5% of patients who undergo surgery are now octogenarians.
From his own data and analysis, Dr. Weder noted that of their last 1,000 consecutive patients undergoing lobectomy/ bilobectomy for lung cancer, mortality for patients aged older than 80 years was 0% (n = 45). “This shows that our selection process was probably not so bad,” he added.
When looking at the actual surgical procedures involved, data again from the ESTS database across 16,461 patients aged younger than <80 years and 622 patients aged 80 years and older show little difference (respectively): sub-lobar resection, 8.2% versus 11.3%; lobectomy, 65.2% versus 66.7%; bilobectomy, 4.9% versus 4.0%; and pneumonectomy, 14.6% versus 10.0%. “Obviously the patients of an older age were not treated so differently to the younger ones,” said Dr. Weder.
Furthermore, over the last decade, pulmonary anatomical resection has become safer, with mortalities down from around 8% to <2%.
“So the question is, with older patients, do they die because of age-related disease, or do they also have differences in cancer-related recurrence-free survival?” asked Dr.Weder.
In this situation, it has been shown that there is indeed little difference in recurrence-free survival between these younger and older patients, and thus the difference is in the overall survival, which is indeed most likely to be related to age and comorbidities.
At the same time, as he saw himself with his recent 88-year-old patient, “many of the elderly patients desire full therapy, and they do not want to be treated differently than younger ones.”
[Presentation title: Any Limit to Surgery for Patients Over 75 Years Old? Session VIII: Elderly and PS2 Patients]