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Select elderly patients with small cell lung cancer appear to derive the same benefit from standard treatment as younger patients with this disease, according to a recent article published in the journal

Cancer. Extensive data was recently analyzed from several U.S. cancer centers which indicate that elderly patients should not be denied treatment options solely on the basis of their age, as they derive comparable benefit as younger patients receiving the same treatments.

Small cell lung cancer (SCLC) accounts for approximately one-quarter of all lung cancers. This cancer differs from other types of lung cancer in that it tends to spread throughout the body very quickly through the blood and lymph vessels. The extent of disease of SCLC is divided into three stages: limited, in which the cancer is present only in one lung and surrounding lymph nodes; extensive, in which the cancer has spread to distant sites in the body; or recurrent, in which the cancer has returned following treatment. The most common form of treatment for patients with limited SCLC is combination chemotherapy, consisting of etoposide and cisplatin, and radiation therapy to the chest, with or without additional radiation therapy to the brain (to prevent cancer recurrence there). Since this is an aggressive cancer, research efforts are ongoing in an attempt to determine the most effective treatment strategies in order to prolong survival in these patients.

Although a large percentage of patients with SCLC are 65 years or older, they often do not receive optimal treatment. Because elderly patients commonly have concurrent illnesses or other medical difficulties that are perceived to exacerbate the side effects of standard therapies, many proven treatments are not offered to this group of patients.

Recently, researchers from several U.S. cancer centers reported the treatment effectiveness and tolerability of standard chemotherapy consisting of etoposide plus cisplatin, administered with either once or twice daily radiation therapy in nearly 400 patients with SCLC. Fifty patients in this study were 70 years or older. A complete or partial disappearance of cancer occurred in 80% of elderly patients. The average time for local cancer return and the duration of response to treatment did not differ between younger and elderly patients. The main complication associated with treatment was the severe lowering of blood cells. This occurred in 61% of younger patients and 84% of elderly patients. The majority of complications from treatment occurring in elderly patients were in those who had concurrent medical problems. Elderly patients derived extended survival benefit when receiving two daily doses of radiation therapy compared to just one daily dose.

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The results from this clinical trial indicate that elderly patients with SCLC, who are in otherwise good health, appear to experience similar benefit from receiving the same treatment as younger patients. Previous clinical trials have demonstrated similar findings, suggesting that elderly lung cancer patients should not be denied treatments soley on basis of their age. Patients with SCLC who are 65 years or older may wish to speak with their physicians about the risks and benefits of receiving standard or aggressive therapy or about the participation in a clinical trial evaluating other promising treatments for the elderly. Two sources of information on ongoing clinical trials that can be discussed with a doctor include listing services provided by the National Cancer Institute ( and also provides personalized clinical trial searches on behalf of patients. (

Cancer, Vol 89, No 9, pp 1953-1960, 2000)

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