Background: Concurrent chemoradiotherapy (CCRT) is the standard treatment for good performance status patients with unresectable stage III non-small-cell lung cancer (NSCLC). However, there is no consensus on the treatment of elderly patients. This study aimed to investigate the treatment outcomes and safety of CCRT in the elderly compared to younger patients.

Methods: We conducted a review of all unresectable stage III patients with NSCLC treated with CCRT from 1999 to 2022 at two Korean hospitals. Progression-free survival (PFS), overall survival (OS) and adverse events (AEs) were compared between patients age ? 70 and those younger than 70 years.

Results: Fifty-one patients were classified 13 as elderly and 38 as younger. The baseline characteristics including performance status and comorbidities were mostly similar. In unadjusted and multivariable adjusted models, elderly and younger patients had similar PFS (HR, 1.07; 95% CI, 0.52 to 2.21 and HR, 0.81; 95% CI, 0.32 to 2.06, respectively). The median PFS in elderly and younger patients were 9.7 and 10.5 months, respectively (P = 0.854). In unadjusted and multivariable adjusted models, elderly patients had worse OS (HR, 2.37; 95% CI, 1.05 to 5.35 and HR, 2.96; 95% CI, 1.07 to 8.19, respectively). The median OS in the elderly and younger patients were 24.1 and 49.9 months, respectively (P =0.032). AEs of all grades were not significant between the elderly and younger patient groups.

Conclusions: Elderly patients experience significantly poorer OS than young patients after CCRT. Therefore, CCRT in elderly patients should always be performed after a detailed discussion of the risks and benefits.