Management of Non-Small-Cell Lung Cancer in the Elderly

Although the selected information from randomized clinical trials for therapeutic management of lung cancer in the elderly seems to need further evaluation, some conclusions can be drawn from the published data. First of all, treatment approaches should be tailored to individual patients and based upon the patient’s biological age and not their chronological age. For early stage lung cancer patients with good performance status and satisfactory cardiopulmonary reserves, the first therapeutic option is represented by surgery. In the presence of contraindications, radiotherapy is the alternative solution. Patients with a locally advanced disease and a good performance status should benefit more from radiochemotherapy, while frail patients should receive radiotherapy alone. Systemic chemotherapy offers the best potential results for metastatic disease. Single-agent chemotherapy with vinorelbine represents the first choice for elderly patients with good performance status, with the alternative of the single agent gemcitabine. In only very selective patients may the use of combination chemotherapeutic agents be given.