To evaluate the nature and scope of treatment for non-small cell lung cancer (NSCLC) in the elderly, we retrospectively analyzed the cases of 166 patients (aged 75 years or more) who had been treated at our hospital between 1986 and 1997. In addition, we assessed the effectiveness and feasibility of combination chemotherapy consisting of ifosfamide and vindesine for 21 elderly patients. As their initial treatment, 20 patients (12%) received surgery; 65 (39%), curative chest radiotherapy; 30 (18%), chemotherapy; and 51 (31%), best supportive care. With combination chemotherapy consisting of ifosfamide (1.6 g/m2 on hospital days 1 through 3) and vindesine (2.5 mg/m2 on days 1 and 8), the response rate was 48% and the median survival time was 13.9 months (95% confidence interval: 5.6-22.2). Grade 3 or 4 leukopenia and neutropenia developed in 76% and 86% of the patients, respectively. However, other toxicities were generally mild, and no treatment-related deaths were observed. The combination of ifosfamide with vindesine may be effective for selected elderly NSCLC patients, and warrants further clinical study.