Real-world treatment patterns for patients 80 years and older with early lung cancer: a nationwide claims study

Lee, Kyungjong; Kim, Hye Ok; Choi, Hee Kyoung; Seo, Gi Hyeon

doi:10.1186/s12890-018-0699-0

Cited by 15 publications

(12 citation statements)

References 23 publications

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“…Local therapies as definitive treatment of these lesions is among the standard managements, especially in patients with surgical contraindications, for instance prohibitive cardiorespiratory risks or inadequate lung function. Among patients newly diagnosed with early stage lung cancer, 5-10% have absolute or relative contraindications to surgery (2,3), but the percentage could be as high as 28% in octogenarians (4). Treatment modalities such as stereotactic body radiation therapy (SBRT) (5), percutaneous ablation techniques for instance radiofrequency (RFA) (6), microwave (MWA) (7) and cryotherapy (8) are highly effective and are associated with reasonable local control rates ranging from 64% to 69.8% at 2 years.…”

Section: Introductionmentioning

confidence: 99%

Transbronchial microwave ablation of lung nodules with electromagnetic navigation bronchoscopy guidance—a novel technique and initial experience with 30 cases

Chan¹,

Lau²,

Ngai³

et al. 2021

Transl Lung Cancer Res

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Background: Microwave ablation of lung nodules may provide a faster, larger and more predictable ablation zone than other energy sources, while bronchoscopic transbronchial ablation has theoretical advantage of fewer pleural-based complications than percutaneous approach. Our study aims to determine whether the novel combination of bronchoscopic approach and microwave ablation in management of lung nodules is technically feasible, safe and effective.Methods: This is a retrospective analysis of a single center experience in electromagnetic navigation bronchoscopy microwave ablation in hybrid operating room. Patients had high surgical risks while lung nodules were either proven malignant or radiologically suspicious. Primary endpoints include technical feasibility and safety.Results: Total of 30 lung nodules from 25 patients were treated. Mean nodule size was 15.1 mm, and bronchus directly leads to the nodules (bronchus sign positive) in only half of them. Technical success rate was 100%, although some nodules required double ablation for adequate coverage. Mean minimal ablation margin was 5.51 mm. The mean actual ablation zone volume was −21.4% compared to predicted, likely due to significant tissue contraction ranging from 0-43%. There was no significant heat sink effect.Mean hospital stay was 1.73 days, and only 1 patient stayed for more than 3 days. Complications included pain (13.3%), pneumothorax requiring drainage (6.67%), post-ablation reaction (6.67%), pleural effusion (3.33%) and hemoptysis (3.33%). After median follow up of 12 months, none of the nodules had evidence of progression.Conclusions: Bronchoscopic transbronchial microwave ablation is safe and feasible for treatment of malignant lung nodules. Prospective study on clinical application of this novel technique is warranted.

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Section: Introductionmentioning

confidence: 99%

Transbronchial microwave ablation of lung nodules with electromagnetic navigation bronchoscopy guidance—a novel technique and initial experience with 30 cases

Chan¹,

Lau²,

Ngai³

et al. 2021

Transl Lung Cancer Res

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“…Therefore, SBRT may be beneficial in elderly patients. According to a national survey in South Korea, the percentage of patients aged ≥ 80 years receiving SBRT as a treatment modality for early NSCLC increased from 9.4% in 2008 to 28.6% in 2016 [ 12 ]. While some studies have revealed that SBRT is an effective and safe treatment modality in elderly patients aged ≥ 80 years [ 13 – 15 ], most studies included patients who were not pathologically confirmed to have NSCLC.…”

Section: Introductionmentioning

confidence: 99%

Lung stereotactic body radiation therapy for elderly patients aged ≥ 80 years with pathologically proven early-stage non-small cell lung cancer: a retrospective cohort study

et al. 2021

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Background Stereotactic body radiation therapy (SBRT) is an established therapy for medically inoperable early-stage non-small cell lung cancer (NSCLC). Many elderly patients are medically inoperable owing to comorbidities. Therefore, SBRT may be a useful therapy for elderly patients. However, the application of SBRT for patients aged ≥ 80 years has not been completely elucidated. Therefore, this study aimed to assess the clinical utility of SBRT for elderly patients aged ≥ 80 years with pathologically proven early-stage NSCLC. Methods We retrospectively evaluated the data of patients aged ≥ 80 years with pathologically proven primary NSCLC who underwent SBRT at our institution between January 2009 and March 2020. Treatment outcomes and toxicities were analyzed. We used the Kaplan–Meier method to estimate survival curves and the log-rank test to compare the survival curves. We performed univariate and multivariate Cox regression analyses. p-values < 0.05 were regarded significant. Results Sixty-four patients (65 lesions) were included, and the median follow-up period was 38.7 (range 3.5–95.7) months. The median age was 82.9 (range 80.0–94.8) years. Sixteen patients were medically operable, and 48 patients were medically inoperable. The prescribed dose of SBRT was either 48 Gy in four fractions or 60 Gy in 10 fractions. The median survival time was 60.0 months (95% confidence interval, 43.5–71.1). The 1-, 3-, and 5-year local control, cancer-specific survival, progression-free survival, and overall survival rates were 98.4%, 98.4%, 81.0%, and 88.9%; 90.1%, 93.7%, 58.9%, and 68.3%; and 87.4%, 83.5%, 38.2%, and 47.5%, respectively. Multivariate analysis revealed that inoperability and solid nodules were the predictors of poor overall survival after SBRT in elderly patients. Two patients (3.1%) had grade 3 radiation pneumonitis, and one patient (1.6%) had grade 5 radiation pneumonitis. Conclusions SBRT was feasible in patients aged ≥ 80 years with NSCLC. It achieved good local control with minimal toxicity. SBRT may be beneficial in elderly patients with early-stage NSCLC.

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“…After SBRT, QoL was maintained, and emotional functioning was improved, whereas QoL worsened after surgery (86). Several studies report similar findings regarding the better or comparable outcomes of SBRT against surgery in elderly patients with NSCLC (87)(88)(89)(90)(91)(92).…”

Section: Rt In the Elderlymentioning

confidence: 77%

Narrative review of immunotherapy and radiation therapy in elderly patients

Chau¹,

LaGuardia²,

Hui³

et al. 2021

Transl Cancer Res TCR

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Cancer is primarily a disease of the elderly, but there is a disproportionate lack of data from clinical trials in this population. Oncologists tend to underdiagnose and undertreat geriatric patients with cancer, leading to poor survival outcomes. New therapies or therapeutic combinations such as immunotherapy and stereotactic body radiation therapy (SBRT) can be used in the elderly for better tumor control and survival, with fewer toxicities. The aim of this review is to describe the synergistic effects of immunotherapy and radiation therapy (RT) and to discuss the use of these therapies concurrently and/ or sequentially in the elderly. To gain a fuller picture of their elderly patient's health, physicians may also consider incorporating a comprehensive geriatric assessment (CGA) to evaluate their functional capacity, cognition, physical and mental health, and social supports which we will discuss in this review. It is recommended that oncologists use geriatric assessments in their everyday practice to have better insight on their complex elderly patients, therefore providing them a higher quality of care. They should also be incorporated in clinical trials as a way to assess and include more elderly patients in the study. Ultimately, the elderly deserve to be treated with more than their chronological age in mind, and new combination therapies and use of a geriatric assessment can help achieve that.

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Real-world treatment patterns for patients 80 years and older with early lung cancer: a nationwide claims study

Cited by 15 publications

References 23 publications

Transbronchial microwave ablation of lung nodules with electromagnetic navigation bronchoscopy guidance—a novel technique and initial experience with 30 cases

Transbronchial microwave ablation of lung nodules with electromagnetic navigation bronchoscopy guidance—a novel technique and initial experience with 30 cases

Lung stereotactic body radiation therapy for elderly patients aged ≥ 80 years with pathologically proven early-stage non-small cell lung cancer: a retrospective cohort study

Narrative review of immunotherapy and radiation therapy in elderly patients

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