Non-small cell lung cancer in octogenarian patients – The experience in a tertiary university hospital
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(B) The second chest CT showing posteromedial hepatization of the left lower field, compatible with superimposed infection. (C) CT angiography showing the anomalous artery arising from the thoracic aorta. (D) CT angiography images showing the venous drainage (arrow) to the pulmonary veins. (E¿F) 3D CT reconstructions showing the anomalous artery." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Silva, J. Vale, A. Reis" "autores" => array:3 [ 0 => array:2 [ "Iniciales" => "E." "apellidos" => "Silva" ] 1 => array:2 [ "Iniciales" => "J." "apellidos" => "Vale" ] 2 => array:2 [ "Iniciales" => "A." 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Oliveira, L. Martins, M. Félix" "autores" => array:3 [ 0 => array:2 [ "Iniciales" => "A." "apellidos" => "Oliveira" ] 1 => array:2 [ "Iniciales" => "L." "apellidos" => "Martins" ] 2 => array:2 [ "Iniciales" => "M." "apellidos" => "Félix" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0873215915364981?idApp=UINPBA00004E" "url" => "/08732159/0000002100000005/v0_201604141143/X0873215915364981/v0_201604141143/en/main.assets" ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Non-small cell lung cancer in octogenarian patients – The experience in a tertiary university hospital" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "281" "paginaFinal" => "282" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "H. Dabó, R. Gomes, V. Hespanhol, H. Queiroga" "autores" => array:4 [ 0 => array:4 [ "Iniciales" => "H." "apellidos" => "Dabó" "email" => array:1 [ 0 => "hansdabo@yahoo.com.br" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "Iniciales" => "R." "apellidos" => "Gomes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 2 => array:3 [ "Iniciales" => "V." "apellidos" => "Hespanhol" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] 3 => array:3 [ "Iniciales" => "H." "apellidos" => "Queiroga" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Pulmonology Department of Centro Hospitalar de São João, Oporto, Portugal" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Pulmonology Department of Hospital Sousa Martins, Unidade Local de Saúde – Guarda, Portugal" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "School of Medicine, University of Oporto, Oporto, Portugal" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "<span class="elsevierStyleSup">*</span>" "correspondencia" => "Corresponding author. hansdabo@yahoo.com.br" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "320v21n05-90436499fig1.jpg" "Alto" => 1564 "Ancho" => 1353 "Tamanyo" => 163625 ] ] "descripcion" => array:1 [ "en" => "Kaplan¿Meier survival curves according to treatment performed (surgery, other non-surgical treatments and best supportive care)." ] ] ] "textoCompleto" => "<p class="elsevierStylePara">Dear Editor,</p><p class="elsevierStylePara">Lung cancer is the most common cancer worldwide, and the leading cause of cancer-related death.<a href="#bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> It is considered a disease of the elderly, and octogenarians represent a rapidly growing population of patients diagnosed with this disease.<a href="#bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> Despite this, the evidence-based standard of care for these patients is limited. Therefore, the clinical practice in this population often poses challenges to clinicians.</p><p class="elsevierStylePara">The authors report the incidence, clinical characteristics, treatment and prognosis of non-small cell lung cancer (NSCLC) in octogenarian patients (80 years and over), in a tertiary academic hospital in Oporto, Portugal. We retrospectively evaluated 1292 patients newly diagnosed with lung cancer, from January 2009 to December 2014. For the purpose of analysis, only patients with NSCLC that had a follow-up in our center were included.</p><p class="elsevierStylePara">Ninety-two octogenarians were included (7.1% of total), 79.3% (<span class="elsevierStyleItalic">n</span> = 73) were male with a median age of 82.0 years (80–90). Smoking history was present in 65% (<span class="elsevierStyleItalic">n</span> = 58) of patients. The median time from symptom onset to diagnosis was 2.0 months (0–12.0). The diagnosis was obtained by bronchoscopy in 45.7% (<span class="elsevierStyleItalic">n</span> = 42) of patients, transthoracic biopsy guided by CT in 46.7% (<span class="elsevierStyleItalic">n</span> = 43) and blind pleural biopsy in 7.6% (<span class="elsevierStyleItalic">n</span> = 7). Adenocarcinoma was the most common histopathological type, recorded in 51.1% (<span class="elsevierStyleItalic">n</span> = 47) of patients, followed by squamous cell carcinoma in 41.3% (<span class="elsevierStyleItalic">n</span> = 38). Clinical staging revealed 23.8% (<span class="elsevierStyleItalic">n</span> = 22) of patients with stage I and II, 8.7% (<span class="elsevierStyleItalic">n</span> = 8) with III-A and 67.4% (<span class="elsevierStyleItalic">n</span> = 62) with III-B and IV. The initial <span class="elsevierStyleItalic">Performance Status</span> (PS) was 0 and 1 in 60.9% (<span class="elsevierStyleItalic">n</span> = 56) of patients, 2 in 16.3% (<span class="elsevierStyleItalic">n</span> = 15) and 3 and 4 in 22.8% (<span class="elsevierStyleItalic">n</span> = 21). After careful consideration, the following treatments were performed: surgery in 5.4% (<span class="elsevierStyleItalic">n</span> = 5), surgery followed by adjuvant chemotherapy in 1.1% (<span class="elsevierStyleItalic">n</span> = 1), chemotherapy only in 17.4% (<span class="elsevierStyleItalic">n</span> = 16), chemotherapy plus conventional radiotherapy in 8.7% (<span class="elsevierStyleItalic">n</span> = 8), conventional radiotherapy in 5.4% (<span class="elsevierStyleItalic">n</span> = 5) and stereotactic body radiation therapy (SBRT) in 2.2% (<span class="elsevierStyleItalic">n</span> = 2). Most patients (58.7%, <span class="elsevierStyleItalic">n</span> = 54) were submitted to best supportive care (BSC), two-thirds presenting PS ≥ 2. <span class="elsevierStyleItalic">Platinum</span>-<span class="elsevierStyleItalic">based doublet regimens</span> were used in one-third of patients submitted to chemotherapy. Surgery was performed on 6 patients: lobectomy and mediastinal lymph node dissection in 3, lobectomy without mediastinal lymph node dissection in 1, segmentectomy in 1 and atypical lung resection in 1. Using Charlson Comorbidity Index, all patients scored high, even the potential surgical candidates, reducing the number of surgeries performed. One postoperative death was the major complication encountered. During the follow-up period, 38% (<span class="elsevierStyleItalic">n</span> = 35) of octogenarians are still alive, 53.5% (<span class="elsevierStyleItalic">n</span> = 49) died and 8.7% (<span class="elsevierStyleItalic">n</span> = 8) were lost to follow-up. In Kaplan–Meier analyses, the median survival rate was about 2.5 months in the BSC group and 12.5 months for those submitted to other non-surgical treatments. More than 80.0% of patients who had surgery are still alive (<a href="#f0005" class="elsevierStyleCrossRefs">Figure 1</a>).</p><a name="f0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="320v21n05-90436499fig1.jpg" alt="Kaplan–Meier survival curves according to treatment performed (surgery, other non-surgical treatments and best supportive care)."></img></p><p class="elsevierStylePara">Figure 1. Kaplan–Meier survival curves according to treatment performed (surgery, other non-surgical treatments and best supportive care).</p><p class="elsevierStylePara">With social and medical evolutions, and consequently global aging, it is expected that more elderly will be affected by lung cancer. For clinicians, it will be increasingly a challenge to manage these patients because they usually have a high burden of comorbidities, a high risk of complications and shorter life expectancy.<a href="#bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">, </span><a href="#bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> Thus, some clinicians are reluctant to propose anticancer treatments (including surgery) to octogenarians. Nevertheless, surgery is the best chance of a cure,<a href="#bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> and should not be denied based on older age alone. Furthermore, the mortality rates associated to surgery have reached acceptable levels.<a href="#bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a> In our study, we found that more than 40% of patients were submitted to some form of anticancer treatment. Only a minority of octogenarians presented in surgical staging, and only just over a quarter of them were submitted to surgery, with acceptable outcomes. The presence of significant comorbidities was a major reason for excluding surgery. In patients with contraindications to surgery, SBRT has emerged as an attractive treatment option.<a href="#bib13" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> Two of our patients had SBRT, without significant morbidity. Chemotherapy was also performed in about a quarter of patients. In a recent study, octogenarians with NSCLC treated with chemotherapy showed prolonged survival compared with those submitted to BSC.<a href="#bib14" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a></p><p class="elsevierStylePara">Our results suggest that selected octogenarians with NSCLC, regardless of age, may benefit from specific anticancer treatment. Thus, a multidisciplinary assessment is recommended. Further studies are warranted to provide an optimal treatment approach for octogenarians.</p><a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare.</p><p class="elsevierStylePara">Corresponding author. hansdabo@yahoo.com.br</p>" "pdfFichero" => "320v21n05a90436499pdf001.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "320v21n05-90436499fig1.jpg" "Alto" => 1564 "Ancho" => 1353 "Tamanyo" => 163625 ] ] "descripcion" => array:1 [ "en" => "Kaplan¿Meier survival curves according to treatment performed (surgery, other non-surgical treatments and best supportive care)." ] ] 1 => array:6 [ "identificador" => "fig2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "descripcion" => array:1 [ "en" => "Kaplan–Meier survival curves according to treatment performed (surgery, other non-surgical treatments and best supportive care)." ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib8" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "A review of the management of elderly patients with non-small-cell lung cancer. 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" "fecha" => "2015" "volumen" => "14" "paginaInicial" => "1073" "paginaFinal" => "1081" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08732159/0000002100000005/v0_201604141143/X087321591536499X/v0_201604141143/en/main.assets" "Apartado" => array:4 [ "identificador" => "50820" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letter to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/08732159/0000002100000005/v0_201604141143/X087321591536499X/v0_201604141143/en/320v21n05a90436499pdf001.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X087321591536499X?idApp=UINPBA00004E" ]
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| 2022 March | 36 | 58 | 94 |
| 2022 February | 48 | 41 | 89 |
| 2022 January | 75 | 45 | 120 |
| 2021 December | 34 | 48 | 82 |
| 2021 November | 41 | 40 | 81 |
| 2021 October | 41 | 50 | 91 |
| 2021 September | 32 | 29 | 61 |
| 2021 August | 34 | 29 | 63 |
| 2021 July | 40 | 23 | 63 |
| 2021 June | 31 | 31 | 62 |
| 2021 May | 61 | 32 | 93 |
| 2021 April | 130 | 76 | 206 |
| 2021 March | 71 | 23 | 94 |
| 2021 February | 36 | 18 | 54 |
| 2021 January | 36 | 23 | 59 |
| 2020 December | 45 | 9 | 54 |
| 2020 November | 33 | 25 | 58 |
| 2020 October | 32 | 15 | 47 |
| 2020 September | 63 | 18 | 81 |
| 2020 August | 51 | 27 | 78 |
| 2020 July | 87 | 29 | 116 |
| 2020 June | 73 | 18 | 91 |
| 2020 May | 75 | 21 | 96 |
| 2020 April | 81 | 25 | 106 |
| 2020 March | 76 | 18 | 94 |
| 2020 February | 64 | 21 | 85 |
| 2020 January | 77 | 15 | 92 |
| 2019 December | 64 | 19 | 83 |
| 2019 November | 64 | 10 | 74 |
| 2019 October | 60 | 27 | 87 |
| 2019 September | 58 | 17 | 75 |
| 2019 August | 116 | 11 | 127 |
| 2019 July | 98 | 15 | 113 |
| 2019 June | 110 | 10 | 120 |
| 2019 May | 167 | 25 | 192 |
| 2019 April | 98 | 21 | 119 |
| 2019 March | 117 | 12 | 129 |
| 2019 February | 103 | 9 | 112 |
| 2019 January | 121 | 23 | 144 |
| 2018 December | 65 | 10 | 75 |
| 2018 November | 13 | 0 | 13 |
| 2018 October | 28 | 7 | 35 |
| 2018 September | 21 | 10 | 31 |
| 2018 August | 31 | 29 | 60 |
| 2018 July | 29 | 17 | 46 |
| 2018 June | 29 | 13 | 42 |
| 2018 May | 37 | 15 | 52 |
| 2018 April | 46 | 22 | 68 |
| 2018 March | 81 | 9 | 90 |
| 2018 February | 18 | 20 | 38 |
| 2018 January | 38 | 9 | 47 |
| 2017 December | 54 | 25 | 79 |
| 2017 November | 20 | 10 | 30 |
| 2017 October | 7 | 13 | 20 |
| 2017 September | 12 | 18 | 30 |
| 2017 August | 18 | 12 | 30 |
| 2017 July | 15 | 12 | 27 |
| 2017 June | 11 | 16 | 27 |
| 2017 May | 15 | 15 | 30 |
| 2017 April | 6 | 5 | 11 |
| 2017 March | 7 | 3 | 10 |
| 2017 February | 4 | 4 | 8 |
| 2017 January | 7 | 4 | 11 |
| 2016 December | 9 | 4 | 13 |
| 2016 November | 11 | 7 | 18 |
| 2016 October | 3 | 4 | 7 |
| 2016 September | 5 | 5 | 10 |
| 2016 August | 9 | 6 | 15 |
| 2016 July | 11 | 13 | 24 |
| 2016 June | 0 | 16 | 16 |
| 2016 May | 0 | 8 | 8 |
| 2016 April | 15 | 6 | 21 |
| 2016 March | 21 | 16 | 37 |
| 2016 February | 27 | 15 | 42 |
| 2016 January | 22 | 17 | 39 |
| 2015 December | 57 | 33 | 90 |
| 2015 November | 69 | 45 | 114 |
| 2015 October | 84 | 52 | 136 |
| 2015 September | 129 | 103 | 232 |
Show all
