Stereotactic Ablative Radiation Therapy is Highly Safe and Effective for Elderly Patients With Early-stage Non-Small Cell Lung Cancer

Brooks, Eric D.; Sun, Bing; Zhao, Lina; Komaki, Ritsuko; Liao, Z.; Jeter, Melenda; Welsh, James W.; O’Reilly, Michael S.; Gomez, Daniel R.; Hahn, Stephen M.; Heymach, John V.; Rice, David C.; Chang, Joe Y.

doi:10.1016/j.ijrobp.2016.12.022

Cited by 43 publications

(26 citation statements)

References 39 publications

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“…Another study regarding the safety of definitive SBRT in patients more than 80 years old suggested its high efficacy and tolerability [ 11 ]. Of interest, a prior study that investigated the effectiveness of SBRT at a single center reported that the OS rates for patients over 75 years were 86% at 1 year, 57.5% at 3 years, and 39.5% at 5 years [ 22 ], which is comparable to the survival rates of 79.1% at 1 year, 61.3% at 3 years, and 32.4% at 5 years in our patients who underwent SBRT.…”

Section: Discussionsupporting

confidence: 67%

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

et al. 2018

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BackgroundOld age is an important factor that could affect the treatment of early-stage lung cancer. In this study, we evaluated the treatment patterns and outcomes of patients over the age of 80 years who had been diagnosed with early-stage lung cancer in real-world practice.MethodsElderly patients who were diagnosed with early-stage lung cancer between 2008 and 2016 were identified using claims data provided by the Health Insurance Review and Assessment Service. The proportion of patients who underwent surgical resection or stereotactic body radiation therapy (SBRT), practice pattern trends, and overall survival (OS) were analyzed from the population-based data.ResultsOver 9 years, 1,684 patients underwent surgical resection (74.9%) or SBRT (25.1%) as a localized treatment. From 2008 to 2016, the treatment modality changed: the percentage of patients who underwent surgical resection decreased from 90.6 to 71.4%, and those who underwent SBRT increased from 9.4 to 28.6%. The percentage of patients treated with SBRT increased over time (p < 0.001). The median OS was 56.4 months in the surgery group and 35.5 months in the SBRT group. The SBRT group showed worse OS compared with the surgery group (Adjusted hazard ratio, 1.44; 95% confidence interval, 1.21–1.72; p < 0.001).ConclusionChanges in local treatment patterns in elderly lung cancer patients were observed and SBRT increased its role in this population. Surgical resection or SBRT should be considered the treatment of choice in elderly patients with localized lung cancer. Further prospective studies are required to elucidate the benefits of surgery and SBRT.

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Section: Discussionsupporting

confidence: 67%

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

et al. 2018

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“…Particularly for elderly patients, SBRT's effectiveness based on lung cancer-specific survival and progression-free survival is the same in the elderly (>75 years old) as it is the average age population (<75 years old). SBRT is well tolerated with a low risk of toxicity (3). Compared to historical outcomes with surgery in the elderly, SBRT outcome is considered comparable for stage I disease but has less morbidity (3).…”

Section: Rt-treatment For Local Controlmentioning

confidence: 99%

“…SBRT is well tolerated with a low risk of toxicity (3). Compared to historical outcomes with surgery in the elderly, SBRT outcome is considered comparable for stage I disease but has less morbidity (3).…”

Section: Rt-treatment For Local Controlmentioning

confidence: 99%

Combining radiation plus immunotherapy to improve systemic immune response

et al. 2018

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Over the past decade, the fields of oncology have made great strides in therapies. The development of new therapeutics and increased understanding of the role of the immune system in the development and treatment of cancer has led to increased collaboration between oncologic fields. Recent technologic advancements in radiation therapy (RT), including stereotactic beam radiation therapy (SBRT), have improved local control and offer an alternative to surgery for the control of oligometastatic disease. Immunotherapy has proven a promising therapeutic in the treatment of metastatic disease but treatment resistance remains a significant obstacle in the majority of patients. Together, radiation and immunotherapy offer potential to eliminate metastatic disease, reduce time to recurrence and improve overall survival. Major obstacles to these positive outcomes include high tumor burden, intratumoral heterogeneity, and the negative effects of tumor stroma, to name a few. Multimodality treatments are under heavy investigation. Promising data from clinical trials is emerging to highlight the value of RT in combination with immunotherapy. However, the mechanisms behind their synergistic effects remain to be fully elucidated. This review aims to highlight the existing literature and offers hypotheses to explain mechanisms behind the synergy of RT and immunotherapy.

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“…Stereotactic body radiation therapy (SBRT) is the usual treatment for medically inoperable patients, and it provides good local control rates and induces minimal toxicity [ 6 – 11 ]. Therefore, SBRT may be beneficial in elderly patients.…”

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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Stereotactic Ablative Radiation Therapy is Highly Safe and Effective for Elderly Patients With Early-stage Non-Small Cell Lung Cancer

Cited by 43 publications

References 39 publications

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

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

Combining radiation plus immunotherapy to improve systemic immune response

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

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