Abstract
ABSTRACTSurgery is the standard modality for early-stage I–II non-small-cell lung cancer (NSCLC). Generally, patients who are >80 years old tend to have more comorbidities and inferior physical status than younger patients. Stereotactic body radiation therapy (SBRT) may provide an alternative treatment for this group of patients. Here, we report our experience using SBRT to in the management of early-stage NSCLC in patients >80 years old. Patients aged ≥80 years old who were diagnosed with early-stage NSCLC and treated with definitive lung SBRT from January 2000 to January 2018 were retrospectively analysed. Local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), cancer-specific survival (CSS), progression-free survival (PFS), overall survival (OS) and treatment-related toxicities were analysed for patients >80 years old. A total of 153 patients were included, with a median age of 85 years (range, 80–94). The median follow-up period and OS was 39.8 months (range, 10–101 months) and 76 months, respectively. The 3-year OS, PFS, CSS, RRFS and LRFS were 65.3, 58.0, 75.7, 73.9 and 85.3%, respectively. Radiation pneumonitis grade 0–1, grade 2, grade 3 and grade 4 was observed in 135 (88.2%), 13 (8.5%), 4 (2.61%) and 1 (0.6%) patient(s), respectively. On multivariate analyses, tumor size, pretreatment C-reactive protein (CRP) value, histology and pretreatment physical state were significantly associated with OS. Definitive lung SBRT appears to have high LRFS and OS without causing high-grade radiation-related toxicities in early-stage NSCLC patients who were >80 years old.
Highlights
Lung cancer is one of the most common malignancies in the world and it is known that the incidence of lung cancer increases as a population ages [1,2,3], treating very old lung cancer patients will become a big common health problem worldwide with the trend of aging populations
A total of 153 patients aged ≥80 years who were diagnosed with earlystage (T1-T2bN0M0) non-small-cell lung cancer (NSCLC) and treated with definite lung Stereotactic body radiation therapy (SBRT) from January 2000 to January 2018 in our institution were included in this single-center retrospective study
All the patients had a Charlson comorbidity index (CCI) score ≥4 because all the patients included in this study were >80 years old, and 96 (62.7%) patients had a CCI core ≥6
Summary
Lung cancer is one of the most common malignancies in the world and it is known that the incidence of lung cancer increases as a population ages [1,2,3], treating very old lung cancer patients will become a big common health problem worldwide with the trend of aging populations. According to the Surveillance Epidemiology and End Results (SEER) database in the USA, the median age of diagnosis of lung cancer was reported to be 71 years in 2016 [4]. In individuals ≥70 years old, lung cancer develops two to three times more frequently than in younger individuals and lung cancer is the leading cause of cancer-related deaths in patients aged ≥80 years [5]. The lung cancer incidence in patients ≥80 years in Japan in 2009 was >700 per 105 population [8]. The life expectancy of Japan in 2065 is projected to reach 84.95 years for men and 91.35 years for women [9], the
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