Stereotactic Body Radiotherapy for Early- stage Non-small- cell Lung Cancer in Patients 80 Years and Older: A Multi- center Analysis

• Type of Material: Article
• Authors: Richard J. Cassidy, Emory University; Pretesh Patel, Emory University; Xinyan Zhang, Emory University; Robert H. Press, Emory University; Jeffrey Switchenko, Emory University; Rathi Pillai, Emory University; Taofeek Owonikoko, Emory University; Suresh Ramalingam, Emory University; Felix Fernandez, Emory University; Seth Force, Emory University; Walter Curran, Emory University; Kristin Higgins, Emory University
• Language: English
• Date: 2017-09-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Elsevier Inc.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.cllc.2017.03.006
• Title of Journal or Parent Work: Clinical Lung Cancer
• ISSN: 1525-7304
• Volume: 18
• Issue: 5
• Start Page: 551
• End Page: +
• Keywords: NSCLC; Octogenarians; RADIATION-THERAPY SBRT; Performance status; Science & Technology; OUTCOMES; AGE; Oncology; Life Sciences & Biomedicine; Nonagenarians; PHASE-II TRIAL; RISK; Radiation pneumonitis; ABLATIVE RADIOTHERAPY; TUMORS; Geriatric oncologic; ELDERLY-PATIENTS; TOXICITY
• Research Categories: Health Sciences, Oncology

Abstract

Stereotactic body radiotherapy (SBRT) for early-stage non–small-cell lung cancer use is evolving, with implementation in a rising geriatric oncologic population. Our study investigated the use of SBRT for non–small-cell lung cancer in 58 consecutive patients ≥ 80 years old at 4 academic centers. SBRT was well-tolerated with expected toxicity rates, excellent disease-specific outcomes, and patients with higher performance status deriving the greatest benefit. Background Stereotactic body radiotherapy (SBRT) is the standard of care for medically inoperable early-stage non– small-cell lung cancer. Despite the limited number of octogenarians and nonagenarians on trials of SBRT, its use is increasingly being offered in these patients, given the aging cancer population, medical fragility, or patient preference. Our purpose was to investigate the efficacy, safety, and survival of patients ≥80 years old treated with definitive lung SBRT. Methods Patients who underwent SBRT were reviewed from 2009 to 2015 at 4 academic centers. Patients diagnosed at ≥80 years old were included. Kaplan-Meier and multivariate logistic regression and Cox proportional hazard regression analyses were performed. Recursive partitioning analysis was done to determine a subgroup of patients most likely to benefit from therapy. Results A total of 58 patients were included, with a median age of 84.9 years (range, 80.1-95.2 years), a median follow-up time of 19.9 months (range, 6.9-64.9 months), a median fraction size of 10.0 Gy (range, 7.0-20.0 Gy), and a median number of fractions of 5.0 (range, 3.0-8.0 fractions). On multivariate analysis, higher Karnofsky performance status (KPS) was associated with higher local recurrence-free survival (hazard ratio [HR], 0.92; P < .01), regional recurrence-free survival (HR, 0.94; P < .01), and overall survival (HR, 0.91; P < .01). On recursive partitioning analysis, patients with KPS ≥75 had improved 3-year cancer-specific and overall survival (99.4% and 91.9%, respectively) compared with patients with KPS < 75 (47.8% and 23.6%, respectively; P < .01). Conclusion Definitive lung SBRT for early-stage non–small-cell lung cancer was efficacious and safe in patients ≥80 years old. Patients with a KPS of ≥75 derived the most benefit from therapy.