Stage I nonsmall cell lung cancer in patients aged ≥75 years

Abstract

BACKGROUND:The number of patients aged !75 years who present with a stage I nonsmall cell lung cancer (NSCLC) is increasing. Elderly patients often have significant comorbidity and may be unfit for surgery. Furthermore, surgery in the elderly is associated with increased mortality and morbidity. In this study, the authors evaluated the outcomes of stereotactic radiotherapy (SRT) in elderly patients. METHODS: Since 2003, 203 tumors in 193 patients aged !75 years were treated using SRT (118 T1 tumors, 85 T2 tumors). The median patient age was 79 years, 80% of patients were considered medically inoperable, and 20% of patients declined surgery. The median Charlson comorbidity score was 4, and severe chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease Class III or greater) was present in 25% of patients. Risk-adapted SRT schemes were used with the same total dose of 60 grays in 3 fractions (33%), 5 fractions (50%), or 8 fractions (17% of patients), depending on the patient's risk for toxicity. RESULTS: SRT was well tolerated, and all but 1 patient completed treatment. Survival rates at 1 year and 3 years were 86% and 45%, respectively. Survival was correlated with performance score (P ¼ .001) and pre-SRT lung function (P ¼ .04). The actuarial local control rate at 3 years was 89%. Acute toxicity was uncommon, and late Radiation Therapy Oncology Group grade !3 toxicity was observed in <10% of patients. CONCLUSIONS: SRT achieved high local control rates with minimal toxicity in patients aged !75 years despite their significant medical comorbidities. These results indicated that more active diagnostic and therapeutic approaches are justified in elderly patients and that SRT should be considered and discussed as a curative treatment alternative. Cancer 2010;116:406-14.

LungTech, an EORTC Phase II trial of stereotactic body radiotherapy for centrally located lung tumours: a clinical perspective

“…37,38 Low rates of toxicity have been observed, including elderly, medically, inoperable patients with severe comorbidities. 6,8,35,36,39,40 Survival after SBRT is modest (approximately 50% at 3 years) but has to be interpreted in the context of patients with multiple comorbidities. As expected, survival after SBRT is higher in fitter, operable patients who refused surgery.…”

The role of stereotactic body radiation therapy (SBRT) in the treatment of oligometastatic disease in the elderly

“…SBRT demonstrated improved local control (LC) and survival rates compared with observation and with standard radiotherapy. [7][8][9] As per the authors' knowledge, there are no studies on the use of SBRT in oligometastatic patients focusing on an elderly and fragile population.…”

“…Patient tolerance and DSS data suggested that SBRT could be attractive for these patients (no $ Grade 3 early or late toxicity was observed). Haasbeek et al 7 showed on a cohort of 193 patients aged $ 75 years, that SBRT in Stage I NSCLC lead to high LC (88% at 1 year) rates with minimal toxicity despite the presence of major comorbidities. 60% of patients reported no early toxicity; the main reported effect at 3 months was fatigue (33%).…”

Treatment Approach for Lung Cancer of Geriatric Patients

“…Kısa sürede tedaviyi bitirme ve ciddi yan etkileri olmaması SBRT için avantajdır. [18,19] İleri yaş kanser hastalarında uygulanması gerekenden daha az tedavi alması sonucu sağ kalımda azalma veya standart tedaviye bağlı yan etkilerin daha fazla ortaya çıkması ile morbidite ve mortalitede artış görülmektedir. İleri yaş tek başına kanser tedavisinin yapılmasına engel olmamalıdır.…”