Geriatric screening tools in older patients undergoing concurrent chemoradiotherapy for locally advanced non-small cell lung cancer.

[INTRODUCTION] Comprehensive geriatric assessment (CGA) is recommended for selecting intensive therapy in older patients, but concerns about time and effort hinder its use. This retrospective study aimed to evaluate associations between geriatric screening tools' results and compliance, toxicity, and survival in older patients with locally advanced non-small cell lung cancer being considered for concurrent chemoradiotherapy (CCRT).

[MATERIALS AND METHODS] From 2012 to 2020, 108 patients aged >75, with an ECOG score of ≤1, and undergoing CCRT were included. Clinical characteristics and blood markers, including sex, Charlson Comorbidity Index (CCI), complete blood count, serum albumin, and C-reactive protein were collected within two weeks of radiotherapy initiation. Glasgow prognostic score (GPS) and Geriatric 8 (G8) scores were calculated. A G8 score of ≤14 was indicative of frailty.

[RESULTS] The median age was 78.5 (range, 76-85). Altogether, 47 patients (43.5 %) had a CCI of 0, while 42 (38.9 %) had a G8 of ≤14. Altogether, 96 patients (88.9 %) were compliant with the treatment plan. The median overall survival (OS) was 21 months, with two- and five-year OS of 43.5 % and 25.8 %, respectively. Two-year progression-free survival (PFS) was 25.0 %, and five-year PFS was 16.3 %, with a median of nine months. Compliance was 85.7 % for patients with a G8 score of ≤14 and 90.9 % for those with a score > 14 (p = 0.40). Compliance was 92.0 % in GPS 0 and 88.0 % in GPS 1-2 (p = 0.57). G8 ≤ 14 showed grade 3 or higher pneumonitis than G8 > 14 (16.7 % vs. 4.5 %, p = 0.034). In multivariate analysis, a G8 of ≤14 and a GPS of ≥1 were poor prognostic factors for both OS and PFS. Altogether, 65 patients (60.2 %) died of lung cancer-specific deaths (LCD) and 20 (18.5 %) died of non-lung cancer-specific deaths (NLCD). In multivariate analysis, GPS (p = 0.001) was significantly associated with LCD, while the G8 score (p = 0.048) correlated with NLCD.

[DISCUSSION] Both the GPS and G8 score predict survival outcomes, with GPS more strongly associated with LCD and the G8 score with NLCD. Further studies are needed to explore CGA in patients with low G8 scores to better manage these vulnerable individuals.