Table Of ContentManagement of Cancer in Older People 4
Series Editor: Riccardo A. Audisio
Cesare Gridelli
Riccardo A. Audisio Editors
Management of
Lung Cancer
in Older People
Management of Lung Cancer in Older People
Cesare Gridelli (cid:129) Riccardo A. Audisio
Editors
Riccardo A. Audisio
Series Editor
Management of Lung
Cancer in Older People
Editors
Cesare Gridelli, MD Riccardo A. Audisio, MD, FRCS
Department of Oncology/Hematology University of Liverpool
S.G. Moscati Hospital St Helens Teaching Hospital
Avellino St Helens
Italy UK
Series Editor
Riccardo A. Audisio MD, FRCS
University of Liverpool
St Helens Teaching Hospital
St Helens
UK
ISBN 978-0-85729-792-1 ISBN 978-0-85729-793-8 (eBook)
DOI 10.1007/978-0-85729-793-8
Springer London Heidelberg New York Dordrecht
Library of Congress Control Number: 2013937329
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Preface
Dramatic epidemiological changes are presently taking place in the western world
as well as in rapidly developing countries such as China and India. These deep
modi fi cations in the distribution of malignant tumors impose a reassessment of our
clinical practice. In the UK, 155,000 people aged >70 years are diagnosed with
cancer every year. They represent 50% of all cancer diagnosis, and this number is
expected to increase substantially over the next decades.
Cancer survival is poorer in senior patients than in the younger ones; numerous
reasons have been taken into account to explain this phenomenon: delayed diagno-
sis, inaccurate staging, substandard treatment, and even patients’ refusal. The com-
mon denominator is lack of knowledge: physicians are not entirely aware of how
aggressive they can be in their treatment; patients are not adequately informed of the
real risks of medical, surgical, and radiation management. This lack of knowledge
is the result of the insuf fi cient number of clinical investigations including older
patients. When randomized clinical trials cannot be undertaken, good-quality epide-
miological data should be made available to guide clinicians, patients, and their
families.
The aim of this book is to provide a comprehensive collection of expert opinions
on the important topic of lung cancer in older patients. An international panel of
opinion leaders on this topic has generously contributed to this project. We would
like to congratulate all contributors and acknowledge them for their time and efforts.
The editors wish to acknowledge the enthusiastic editorial support of Margaret
Burns and the Springer team.
Cesare Gridelli, MD
Riccardo A. Audisio, MD, FRCS
v
Contents
Part I Background and Epidemiology
1 Basic Science of Lung Cancer in Older Patients . . . . . . . . . . . . . . . 3
Morena Fasano, Flavia Cantile, Floriana Morgillo,
and Fortunato Ciardiello
2 Clinical Epidemiology and the Impact of Comorbidity
on Treatment and Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Maryska L.G. Janssen-Heijnen
Part II Special Considerations in the Management of Older Patients
3 Physiological Assessment and Cardiopulmonary
Exercise Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Paul P. Walker, Malcolm West, Michael P.W. Grocott, and Sandy Jack
4 A Practical Mini-Guide to Geriatric Assessment . . . . . . . . . . . . . . . 53
Siri Rostoft Kristjansson
5 Impact of the Physiological Effects of Aging
on the Pharmacokinetics and Pharmacodynamics
of Systemic Lung Cancer Treatment . . . . . . . . . . . . . . . . . . . . . . . . . 65
Antonio Rossi, Dario Cova, Silvana Leo, and Lazzaro Repetto
6 Drug Interactions and Polypharmacy . . . . . . . . . . . . . . . . . . . . . . . . 89
Silvana Leo, Dario Cova, Antonio Rossi, and Lazzaro Repetto
Part III Diagnostics
7 Selection of Appropriate Surgery
for Early Lung Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Michael T. Jaklitsch and Weston Sacco
vii
viii Contents
Part IV Non Small-Cell Lung Cancer: Treatment of Early Stages
8 Surgery: Indications and Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Lorenzo Spaggiari and Domenico Galetta
9 Is There a Role for Postoperative Radiotherapy
in Elderly Patients with Early-Stage Non-small
Cell Lung Cancer? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Nicolas Girard and Françoise Mornex
10 Is There a Role for Neoadjuvant Chemotherapy
in Older Patients? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Alejandro Navarro and Enriqueta Felip
11 Curative Radiotherapy in Patients Inoperable
for Medical Reasons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Naomi E. Verstegen and Suresh Senan
Part V Non Small-Cell Lung Cancer: Treatment
of Locally Advanced Disease
12 Adjuvant Chemotherapy: Feasibility in the Elderly
and Patient Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Alejandro Navarro and Enriqueta Felip
13 Locally Advanced Non-Small Cell Lung Cancer in the Elderly:
What Combination of Therapy Is Best? . . . . . . . . . . . . . . . . . . . . . . 173
Steven E. Schild
Part VI Non Small-Cell Lung Cancer: Treatment of Advanced Disease
14 First-Line Treatment and the New Paradigm
of Histology-Based Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Cesare Gridelli, Antonio Rossi, and Paolo Maione
15 Treatment of Frail Patients and Octogenarians
with Advanced NSCLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Cesare Gridelli, Paolo Maione, and Antonio Rossi
16 Are Second- and Third-Line Treatments
in the Elderly Feasible? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Cesare Gridelli, Antonio Rossi, and Paolo Maione
Contents ix
Part VII Small-Cell Lung Cancer: Therapeutics
17 Treatment of Limited-Stage Disease in Older Patients:
The Role of Thoracic Radiotherapy and Prophylactic
Cranial Irradiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Rovel J. Colaco, Anna P. Britten, Fiona H. Blackhall,
and Corinne Faivre-Finn
18 Chemotherapy in the Elderly: Standard Chemotherapy
or Specific Regimens? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Paul Wheatley-Price and Frances A. Shepherd
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
