SBRT is very effective for stage I NSCLC. Biologically effective doses (BED) >100 Gy are recommended. Elderly patients and those with a limited performance status may not tolerate these high doses. This study investigated the outcomes after lower dose SBRT (BED < 90 Gy) in 46 patients with stage I NSCLC, who were aged ≥70 years or in reduced general condition. Local control rates at 1, 2, and 3 years were 100, 95, and 95 %, respectively. Rates of freedom from distant progression were 83, 63, and 54 %, and survival rates were 77, 57, and 36 %, respectively. Seventeen patients died during the follow-up, 11 (65 %) from distant progression of NSCLC, and six (35 %) from non-malignant causes. No patient developed radiation-induced pneumonitis. Thus, SBRT with BED <90 Gy resulted in excellent local control and appears to be a reasonable option for stage I NSCLC in elderly patients and those with a poor performance status.
The Charlson Comorbidity Index plus three comorbidity scales were evaluated for survival after radiochemotherapy of limited stage SCLC. For the Charlson Comorbidity Index, 2-4 points were compared to 5-8 points. For the Age-Comorbidity Score, 2-6 points were compared to 7-10 points. For the Medical Research Council (MRC) Breathlessness Scale, grades 0-2 were compared to grades 3-5. For the Simplified Comorbidity Score, 0-5 points were compared to 6-11 and 12-17 points. Charlson Comorbidity Index (p = 0.022) and MRC Breathlessness Scale (p < 0.001) showed significant associations with survival, the Age-Comorbidity Score a trend (p = 0.06). For the Simplified Comorbidity Score, no significant correlation was found (p = 0.54). Absolute differences in survival ≥20 % were observed for the MRC Breathlessness Scale at 1, 2, and 3 years, for the Charlson Comorbidity Index at 1 year, and for the Age-Comorbidity Score at 2 years. Thus, particularly the MRC Breathlessness Scale can contribute to personalization of the treatment of SCLC.
Karnofsky performance score was identified as predictor of survival and should be considered when assigning the radiation regimen to patients with metastatic bile duct cancer.
A survival scoring system for patients receiving SBRT for very few lung metastases was developed. This score allowed us to estimate the survival prognosis of these patients and can aid physicians when aiming to choose the optimal SBRT dose for individual patients.
This score including three groups with significantly different survival rates is a helpful instrument for personalization of therapy for patients with LD-SCLC. When using this instrument, the limitations if this study must be taken into account.
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