Survival after stereotactic radiotherapy in patients with early-stage non-small cell lung cancer

Abstract

Introduction: Stereotactic radiotherapy (SBRT) is the treatment of choice for inoperable early stage non-small cell lung cancer (NSCLC). We report analyses of the influence of age on survival after SBRT. Methods and material: From 2005 to 2017, 544 previously un-irradiated patients with early stage NSCLC had SBRT. The data were analyzed in four age groups: A:-69 (176 pts), B: 70-74 (115 pts), C: 75-79 (131 pts) and D: 80 years or older (122 pts). Two SBRT dose regimes were used: 45 Gy/3F (N ¼ 103) and 66 Gy/3F (N ¼ 441). Results: All patients had a follow up (time to censoring, FU) of at least 16 months, the median FU being 48.0 months. The median age was 74.4 years. The overall survival (OS) was associated with age. The median OS was 50.7, 45.9, 45.4 and 33.0 months, and the 5-year OS was 45%, 32%, 33% and 18% in groups A, B, C and D, respectively. No difference was found between groups B and C, while OS in group A was significantly better than remaining groups, and the OS in group D significantly poorer. In multivariable analyses, OS was heavily influenced by age, Charlson's comorbidity index (CCI) and performance status (PS). For lung cancer-specific survival (LCSS), only increasing tumor diameter and PS were associated with poor survival. Conclusions: The OS was influenced by age, but the study suggests that a cut point of 75 year is inappropriate in evaluating the effect of old age on survival.

Predictive clinical and dosimetric parameters for risk of relapse in early-stage non-small cell lung cancer treated by SBRT: A large single institution experience

“…The 3-year CSS and DFS rates in the present study were also close to those of patients treated with surgery [25] . In multivariate analysis, we found that good general condition and female gender were correlated with better overall survival as in previous studies [26] . However, no parameter was independently significant for CSS or DFS.…”

Evaluating intra‐fractional tumor motion in lung stereotactic radiotherapy with deep inspiration breath‐hold

“…Stereotactic body radiation therapy (SBRT) has played a crucial role in lung cancer treatment and shown efficient local control according to reported outcomes. [1][2][3][4] The success of lung SBRT relies on the accuracy of treatment delivery. The respiratory motion of the lung tumor poses a significant challenge in SBRT and is considered one of the largest sources of uncertainty.…”

Clinical experience of volumetric‐modulated flattening filter free stereotactic body radiation therapy of lesions in the lung with deep inspiration breath‐hold

“…3 Hansen et al reported that the overall survival in 544 inoperable patients with early NSCLC treated with SBRT was 43.9 months, and the 5-year OS was the highest (45%) for patients under 70 years of age. 4 Pooled data from two independent randomized phase 3 trials of SBRT in patients with operable stage I NSCLC versus lobectomy demonstrated 3-year survival rates of 95% versus 79% in the SBRT and lobectomy groups, respectively. 5 These studies show that a number of patients survive for longer periods of time and may experience detrimental long-as well as short-term effects of RT.…”