Stereotactic Ablative Radiation Therapy is Highly Safe and Effective for Elderly Patients With Early-stage Non-Small Cell Lung Cancer

Abstract

To discern the effectiveness and toxicity of stereotactic ablative radiation therapy (SABR) in the elderly population (aged ≥75years) and to consider how SABR outcomes compare with surgical outcomes historically reported in the elderly. A total of 772 patients with clinical early-stage I-II non-small cell lung cancer (NSCLC; stage T1-T3N0M0) underwent SABR (50Gy in 4 fractions or 70Gy in 10 fractions) from 2004 to 2014 at our center (n=442, aged <75years; n=330, aged ≥75years). The primary endpoints included overall survival (OS), time-to-progression, and grade ≥3 toxicity. The median follow-up time was approximately 55months. Compared with patients aged <75years, those aged ≥75years had no difference in the time-to-progression (P=.419), lung cancer-specific survival (P=.275), or toxicity (P=.536). OS was the same between both age groups at 2years of follow-up but diverged thereafter, with patients aged <75years when treatment began having greater OS rates at 5years. The median OS rates for patients aged ≥75years were 86% at 1year, 57.5% at 3years, and 39.5% at 5years. The median OS rates for patients aged <75years were 87.3% at 1year, 67.6% at 3years, and 51.5% at 5years. No patient aged ≥75years experienced any grade 4 or 5 toxicity. The effectiveness of SABR was the same for the elderly as for the average-age population according to lung cancer-specific survival and time-to-progression. It also poses no increased toxicity. Compared with the historical outcomes with surgery in the elderly, SABR outcomes can be considered comparable for stage I-II disease but with less morbidity.