A comparative study on sequential single-agent chemotherapy followed by radiation versus single-agent chemotherapy alone in elderly patients of metastatic non-small cell lung cancer

Background: Stage IV non-small cell lung cancer (NSCLC) in elderly patients typically has a poor prognosis and addition of aggressive local therapy to the systemic therapy could provide encouraging outcomes with prolonged survival in certain patients with stage IV NSCLC. Objectives: The aim of this study is to compare the treatment response and progression-free survival (PFS) between single-agent chemotherapy (CT) followed by external-beam radiotherapy versus single-agent CT alone in elderly patients with metastatic NSCLC. Materials and Methods: In a randomized prospective study, after taking Ethical committees approval, 40 patients aged from 60 to 82 years were enrolled and divided into two equal groups: Arm A and Arm B. Both the arms received Gemcitabine 1 g/m2/dose as 30 min intravenous infusion on D1, D8, and D15 of 28-day cycle or D1 and D8 of a 21-day cycle for a total of 3–4 cycles, whereas Arm A received radiation 45–55 Gy @ 180 cgy/fraction after CT. Treatment response and PFS against time were analyzed using Friedman's test and Kaplan − Meier method. P < 0.05 was considered statistically significant. Results: The demographic profiles of the patients were comparable between the two groups. Most patients have Stage IV M1b disease and squamous cell carcinoma subtype and bone metastasis. There were marked symptomatic improvements in both the arms. The overall treatment response was 70.0% in Arm A and 50.0% in Arm B with median follow-up was 8 months. Median PFS and overall survival were 5 months and 8 months for arm A, respectively whereas it was 4 months and 7 months for Arm B (P = 0.03). Conclusion: In this study, it was found that sequential single agent CT followed by radiation has shown survival advantage in certain patients with Stage IV NSCLC.