Abstract
BackgroundThe optimal treatment for elderly patients with early-stage non-small cell lung cancer (NSCLC) remains inconclusive. Previous studies have shown that stereotactic body radiotherapy (SBRT) provides encouraging local control though higher incidence of toxicity in elderly than younger populations. The objective of this study was to compare the outcomes of SBRT and surgical treatment in elderly patients with clinical stage I-II NSCLC.MethodsThis retrospective analysis included 205 patients aged ≥70 years with clinical stage I NSCLC who underwent SBRT or surgery at Zhejiang Cancer Hospital (Hangzhou, China) from January 2012 to December 2017. A propensity score matching analysis was performed between the two groups. In addition, we compared outcomes and related toxicity in both study arms.ResultsEach group included 35 patients who met the inclusion criteria. Median follow-up was 50.1 (0.8–74.4) months for surgery and 35.5 (11.5–71.4) months for SBRT. The rate of cancer-specific survival was similar between the two treatment arms (p = 0.958). In patients who underwent surgery, the corresponding 3- and 5-year cancer-specific survival rates were 85.3 and 81.7%, respectively. In those who received radiotherapy, these rates were 91.3 and 74.9%, respectively. Moreover, the 3- and 5-year locoregional control in patients who underwent surgery were 90.0 and 80.0%, respectively. In those who received radiotherapy, these rates were 91.1 and 84.1%, respectively. Notably, the observed differences in progression-free survival were not statistically significant (p = 0.934). In the surgery group, grade 1–2 complications were observed in eleven patients (31%). One patient died due to perioperative infection within 30 days following surgery. There was no grade 3–5 toxicity observed in the SBRT group.ConclusionsThe outcomes of surgery and SBRT in elderly patients with early-stage NSCLC were similar.
Highlights
The optimal treatment for elderly patients with early-stage non-small cell lung cancer (NSCLC) remains inconclusive
Based on the highly promising outcome of stereotactic body radiotherapy (SBRT) in medically inoperable patients, several retrospective studies and prospective trials have shown that overall survival (OS) following SBRT was comparable or even better than that observed with pulmonary resection [7,8,9,10,11,12]
Mediastinal lymph node dissection or sampling was performed in all surgical patients, the number of dissected lymph nodes was 11.2 ± 5.7, with 88% of patients having 6 or more nodes dissected
Summary
The optimal treatment for elderly patients with early-stage non-small cell lung cancer (NSCLC) remains inconclusive. Surgeons are occasionally reluctant to operate in older patients due to the presence of multiple comorbidities or borderline respiratory function [4]. For this reason, the development of less radical approaches is urgently warranted. Stereotactic body radiation therapy (SBRT) is a technique that delivers high radiation dose to a tumor target in a hypo-fractionated schedule [5] Both the National Comprehensive Cancer Network Clinical Practice Guidelines and European Society for Medical Oncology Consensus recommend the use of SBRT as a non-surgical treatment option for stage I-II NSCLC [6]. Considering the suffer from inherent imbalances in the retrospective comparison and relatively short follow-up periods of studies, there is limited data in the relevant literature comparing SBRT to surgery in this patient population
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
