Lower Incidence of Esophagitis in the Elderly Undergoing Definitive Radiation Therapy for Lung Cancer.
INTRODUCTION
Most patients with lung cancer are elderly and poorly represented in randomized clinical trials. They are often undertreated because of concerns about their ability to tolerate aggressive treatment. We tested the hypothesis that elderly patients undergoing definitive lung radiation might tolerate treatment differently than younger patients.


METHODS
A total of 125 patients who underwent definitive lung radiotherapy were identified from a prospective institutional database (University of Michigan cohort). Logistic regression modeling was performed to assess the impact of age on esophagitis grade 2 or higher or grade 2 or higher and pneumonitis grade 3 or higher or grade 2 or higher, with adjustment for esophageal and lung dose, respectively, as well as for chemotherapy utilization, smoking status, and performance status. The analysis was validated in a large cohort of 691 patients from the Michigan Radiation Oncology Quality Consortium registry, an independent statewide prospective database.


RESULTS
In the University of Michigan cohort, multivariable regression models revealed a significant inverse correlation between age and rate of esophagitis for both toxicity levels, (adjusted OR = 0.93 for both models and 95% confidence intervals of 0.88-0.98 and 0.87-0.99), with areas under the curve of 0.747 and 0.721, respectively, demonstrating good fit. This same association was noted in the Michigan Radiation Oncology Quality Consortium cohort. There was no significant association between age and pneumonitis.


CONCLUSIONS
There is a lower incidence of esophagitis with increasing age even after adjustment for use of chemotherapy. This is a novel finding in thoracic oncology. No age dependence was noted for pulmonary toxicity. The elderly are able to tolerate definitive thoracic radiation well and should be offered this option when clinically warranted.
['Soni|Payal D|PD|', 'Boonstra|Philip S|PS|', 'Schipper|Matthew J|MJ|', 'Bazzi|Latifa|L|', 'Dess|Robert T|RT|', 'Matuszak|Martha M|MM|', 'Kong|Feng-Ming|FM|', 'Hayman|James A|JA|', 'Ten Haken|Randall K|RK|', 'Lawrence|Theodore S|TS|', 'Kalemkerian|Gregory P|GP|', 'Jolly|Shruti|S|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D004941:Esophagitis D005260:Female D005500:Follow-Up Studies D006801:Humans D015994:Incidence D008175:Lung Neoplasms D008297:Male D008824:Michigan D008875:Middle Aged D009367:Neoplasm Staging D011379:Prognosis D011446:Prospective Studies D011832:Radiation Injuries D017564:Radiation Pneumonitis D011878:Radiotherapy D015996:Survival Rate
Esophagitis Elderly Radiation Lung Cancer Toxicity