Abstract
BackgroundStereotactic body radiotherapy (SBRT) for non-small cell lung cancer (NSCLC) is primarily a treatment option for medically inoperable patients, who are often elderly. However, few studies report the effects of SBRT in elderly patients. Thus, we retrospectively analyzed clinical outcomes and feasibility following treatment of very elderly patients (age ≥ 85 years) with stage Ι NSCLC and younger patients (age < 85 years) with SBRT in our institution.MethodsFrom January 2006 to December 2012, 81 patients (20 very elderly; median age, 80 years; age range 64–93 years) with stage Ι NSCLC received SBRT. Prescription doses of 48 Gy were delivered in 4 fractions over 2 weeks or doses of 60 Gy were delivered in 10 fractions over 3 weeks.ResultsLocal control was achieved in 91.8% of all patients at 3 years (83.1% and 93.8% of very elderly and younger patients, respectively), and the 3-year overall survival (OS) rate was 69.4% (40.7% and 75.0% of very elderly and younger patients, respectively). OS rates were significantly shorter for the very elderly group than for the younger group, with a 3-year cause-specific survival (CSS) rate of 77.9% (50.4% and 81.6% of very elderly and younger patients, respectively) and a 3-year progression-free survival (PFS) rate of 59.5% (44.7% and 63.5% in very elderly and younger groups, respectively). Multivariate analysis revealed a significant correlation between T stage and OS. Grades 2 and 3 radiation pneumonitis (RP) occurred in 7 (8.6%) and 2 (2.5%) patients, respectively. Among patients of very elderly and younger groups, grade 2 RP occurred in 4 (20%) and 3 (4.9%) patients, and grade 3 occurred in 2 (10%) and 0 (0%) patients, respectively. No grade 4 or 5 toxicity was observed, RP was significantly more severe among very elderly patients.ConclusionsSBRT for stage Ι NSCLC was well tolerated and feasible in very elderly patients. The efficacy of SBRT was comparable to that achieved in younger patients, although very elderly patients experienced significantly more severe RP. Although this study cohort included only 20 very elderly patients, the present data suggest that decreasing volumes of normal lung tissues exposed to ≥ 20 Gy and mean lung doses reduces the risk of RP in very elderly patients. The present data warrant studies of larger very elderly cohorts.
Highlights
Stereotactic body radiotherapy (SBRT) for non-small cell lung cancer (NSCLC) is primarily a treatment option for medically inoperable patients, who are often elderly
Other recent reports indicate that SBRT is an effective treatment option for the elderly, with minimal toxicity [9,10,11,12] and similar overall survival (OS) outcomes to those achieved with surgery [13]
Eligibility criteria Eligibility criteria were as follows: (1) identification of T1N0M0 or T2aN0M0 primary lung cancer according to the Union for International Cancer Control in the 7th lung cancer TNM classification and staging system using computed tomography (CT) of the chest and upper abdomen, bone scintigraphy, and brain magnetic resonance imaging, (2) confirmation of NSCLC from histology or clinical information such as increased maximum standardized uptake valued (SUVmax) on 18-fluoro-deoxyglucose-positron emission tomography (FDG-PET), tumor enlargement on CT images, or elevated tumor marker levels during the observation period, (3) predominantly peripheral localization of the tumor, and (4) arterial oxygen pressure of ≥ 60 mmHg and predicted postoperative forced expiratory volume of ≥ 700 ml at 1 s
Summary
Stereotactic body radiotherapy (SBRT) for non-small cell lung cancer (NSCLC) is primarily a treatment option for medically inoperable patients, who are often elderly. We retrospectively analyzed clinical outcomes and feasibility following treatment of very elderly patients (age ≥ 85 years) with stage Ι NSCLC and younger patients (age < 85 years) with SBRT in our institution. Stereotactic body radiotherapy (SBRT) presents a promising treatment for patients with stage I NSCLC who are medically inoperable or refuse surgery, with improved efficacy and lower complication rates [4,5,6,7]. In the present study, we retrospectively analyzed clinical outcomes and feasibility of SBRT in 20 very elderly patients (≥85 years) with stage Ι NSCLC who exceeded the Japanese life expectancy at birth, and made comparisons with NSCLC patients of < 85 years
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