Clinical Research Of CDDP-based Two-agent Combination Chemotherapy On Elderly Patients With Advanced Non-small Cell Lung Cancer

Objective: An approach of the safety and the short-term effect of chemotherapy on elderly patients with advanced non-small cell lung cancer(NSCLC) by analyzing and comparing the short-term effects and side effects of CDDP-based two-agent combination chemotherapy on elderly group and middle-age group with advance NSCLC. At the same time, carry out the quantitative comparison of the changes in the quality of life and relevant affected factors of the elderly patients with advanced NSCLC before and after the chemotherapy.Method: 68 patients with advanced NSCLC, who had been hospitalized from June 1st, 2005 to Dec. 31st, 2006 and treated by CDDP-based two- agent combination chemotherapy, were divided into elderly group(age>=60 years old) and middle-age group(age<60 years old) according to Chinese age segregation standard. Where, 35 cases in elderly group and 33 cases in middle-age group were studied. Both groups were treated by CDDP-based two-agent combination chemotherapy and the therapeutic effects were evaluated after two-week chemotherapy. The short-term effects and side effects of two groups were compared & analyzed, and make statistical analysis of Chi-square test and non-parametric test by using the statistical software SPSS 13.0. At the same time, using the 3^rd edition of Chinese version of QLQ-C30 provided by European Organization for Research and Treatment of Cancer (EORTC), carry out the quantitative comparison of the changes in the quality of life of the elderly patients on the basis of one day before chemotherapy, as well as seven days and twenty-eight days after the chemotherapy, and take the quantitative analysis of other factors which may affect the quality of life of the elderly patients with advanced NSCLC (including gender, staging, pathology, whether or not have the initial treated, retreated and complicated diseases).Result: the short-term effective rates of elderly group and middle-age group are 28.6% and 33.3% respectively without significant P value in statistics. The clinical benefit rates of elderly group and middle-age group are 77.1% and 81.8% respectively and no significant P value was found in statistics either. Side effects of two groups are mainly bone marrow depression and gastrointestinal reaction. Incidences of side effects are close to each other without statistical difference. Neither chemotherapy-related death nor IV degree adverse reaction was observed in both groups. The comparison of the quality of life before and after the chemotherapy of the elderly group shows that: one week after the chemotherapy, the functional scores and overall situation have declined while the symptom scores have increased; 4 weeks after the chemotherapy, the scores of most items have recovered to the level before the chemotherapy. The nausea and vomiting (NV) and appetite loss symptom scores of chemotherapy effective and ineffective groups on the seventh day after the chemotherapy both increase > 10 points, while the chemotherapy effective group shows the effective improvement in the physical function (PF) scores and quality of life (QOL) scores in the evaluation on the twenty-eighth day after the chemotherapy, and the dyspnea (DY) symptom scores decrease > 10 points. The evaluation of the quality of life on the 28^th day of chemotherapy ineffective group shows similar scores with the ones before the chemotherapy, no obvious changes. The grouping by the factor of whether or not have the complicated diseases and pathology with advanced NSCLC shows no significant difference in the study of this group, all scores of the items are similar. In the grouping by the gender factor, the economic difficulty (FD) scores of female patients increase > 10 points than the male group. In the grouping by staging factor, the functional scores and QOL scores of IV patients show the overall decline, wherein, PF and social function (SF) scores increase, which are effective; while the symptom scores show the overall increase, wherein the increased scores of fatigue (FA), pain (PA) and DY are heavier. In the grouping by initial treated and retreated factor, the increase of emotion function (EF) scores of the retreated group is effective, while the increase of FD scores of retreated group is heavier.Conclusion: Elderly patients with advanced NSCLC in good general condition (KPS>=70) can tolerate CDDP-based two-agent combination chemotherapy, the short-term effects and side effects of which were similar to those on middle-age group. The therapeutic effects of CDDP-based two-agent combination chemotherapy on elderly group were confirmed. Therefore, CDDP-based two-agent combination chemotherapy on elderly patients with advanced NSCLC is safe and feasible, and deserves to be widely applied in clinic. The quality of life and efficacy of chemotherapy of elderly patients with advanced NSCLC are not entirely relevant. In other factors which affect the quality of life, the later of the staging, the more obvious of the decrease trend of the quality of life; the pathology and complicated diseases have little effect on it; while the scoring differences of some items in the factors of the gender and initial treated or retreated are > 10 points.