Do the "oldest old" non-small cell lung cancer patients experience the worst outcomes after radiotherapy?

Background: Older patients with cancer tend to be denied curative treatment because of the perception that they may not be able to tolerate treatment, especially if they are aged ≥80 years. 

Aim: We aimed to verify our hypothesis that patients aged ≥80 years who receive radiotherapy for non-small cell lung cancer fare better than their younger counterparts. 

Methods and Materials: Medical records of all patients with non-small cell cancer who were referred to our institution for radiotherapy between January 1, 2006, and September 30, 2025, were reviewed. All eligible patients completed the planned curative radiotherapy. The patients were categorized into two age groups: <80 and ≥80 years. Toxicity and overall and progression-free survival were compared among age groups. Toxicity was divided into two groups: grades 0–2 or 3<. Multivariate analysis was performed using age, Charlson Scale score, sex, use of concomitant chemotherapy with radiotherapy, and adjuvant use of durvalumab as variables. 

Results: Of the 528 patients, 470 completed radiotherapy. The age distribution was as follows: <80 years, 84% (n=395); and ≥80 years, 16% (n=75). No statistically significant difference in grade 3< toxicity was observed in the older age group. The chemoradiotherapy group had statistically significantly higher incidence rates of neutropenia (p<0.01) and esophagitis (p=0.02) compared with the radiotherapy monotherapy group. Moreover, the incidence rate of pneumonia was higher in the chemoradiotherapy (p=0.01) and adjuvant durvalumab (p=0.01) groups. Although the differences were not statistically significant, we observed higher trends in the incidence rates of thrombocytopenia in the older age (p=0.06) and chemoradiotherapy (p=0.10) groups compared with their counterparts, and neutropenia in male patients (p=0.07) compared with female patients. In the multivariate survival analysis, no statistically significant difference in overall survival was observed. However, the lower disease stage showed higher progression-free survival than the higher disease stage. There was a trend toward longer progression-free survival in the older age and adjuvant durvalumab groups (both p=0.08). 

Conclusion: Compared with their younger counterparts, patients with non-small cell cancer aged ≥80 years showed no statistically significant differences in terms of faring even better after receiving radiotherapy for non-small cell cancer. However, these older patients showed trends of higher rates of severe thrombocytopenia and longer progression-free survival than younger patients. We could not verify our hypothesis; however, curative lung radiotherapy can be an effective and safe treatment for patients aged ≥80 years.