Treatment of small cell lung cancer in the elderly.

OBJECTIVE: Since both the incidence of lung cancer and the proportion of the population over age 65 are increasing rapidly in North America, we undertook a retrospective review of elderly patients with small cell lung cancer (SCLC) in an attempt to assess the effect of age on treatment decisions, response, survival, and toxicity. DESIGN: Retrospective chart view. SETTING: Oncology Unit of a university-affiliated teaching hospital. PATIENTS: There were 123 patients age > 70 years treated from 1976-88. Chemotherapy consisted of either cyclophosphamide, doxorubicin, and vincristine, or etoposide and cisplatin. RESULTS: There were 74 patients aged 70-74, 35 aged 75-80, and 14 aged 80 years or older. No significant differences existed between the groups in sex, stage, performance status, or presence of co-morbid disease. Median survivals for patients with limited and extensive disease were 11.9 and 5.2 months, respectively (P = < 0.0001), with no significant difference for patients in any age group (P = 0.4). For both limited and extensive disease, survival correlated strongly with the treatment received. Twenty-five patients received no treatment (median survival 1.1 months), 20 had radiation only (median 7.8 months), and 27 patients had < 3 cycles of chemotherapy (median 3.9 months). Median survival for the 50 patients who had 4-6 cycles was 10.7 months (limited disease 15.0 months, extensive disease 8.61 months). In the Cox Model, survival correlated strongly with stage of disease and chemotherapy treatment (P < 0.0001), but only marginally with performance status (P < 0.077). Of the 77 patients who had chemotherapy, less than 50% in all age groups completed six cycles. Only two patients completed chemotherapy without a single dose reduction, and 76.7% required more than two reductions. CONCLUSIONS: Chemotherapy should not be withheld from elderly patients with SCLC on the basis of age. The survival of patients who receive chemotherapy is significantly longer than that of untreated patients even though frequent dose reductions for toxicity may be required. The survival benefit is due to treatment effect and is not due to a selection bias in the cohort of patients chosen for therapy.

Cryocrystalglobulinemia mimicking rheumatoid arthritis and vasculitis.

We describe a patient with longstanding arthropathy resembling rheumatoid arthritis (RA) and cold induced purpura for many years, concomitant with IgG kappa paraproteinemia. At autopsy, the patient was found to have evidence of widespread vascular occlusions due to precipitated crystals as well as tissue deposition of crystals. Neither vasculitis nor synovitis was observed despite the clinical picture of both. Blood and synovial fluid obtained antemortem were found to spontaneously form crystals when stored at 4 degrees C, and the washed crystals were composed of the same monoclonal IgG kappa previously found in serum. Cryocrystal formation occurred at 33 degrees C and neutral pH. This patient thus had cryocrystalglobulinemia mimicking clinical manifestations of RA and vasculitis.