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.
Clinical pathology
Elderly
Non-small cell lung carcinoma
Radiosurgery
Stereotactic body radiation therapy
Journal
Radiation oncology (London, England)
ISSN: 1748-717X
Titre abrégé: Radiat Oncol
Pays: England
ID NLM: 101265111
Informations de publication
Date de publication:
23 Feb 2021
23 Feb 2021
Historique:
received:
12
12
2020
accepted:
11
02
2021
entrez:
24
2
2021
pubmed:
25
2
2021
medline:
15
10
2021
Statut:
epublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 33622369
doi: 10.1186/s13014-021-01769-7
pii: 10.1186/s13014-021-01769-7
pmc: PMC7903684
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
39Références
Radiat Oncol. 2019 Nov 7;14(1):195
pubmed: 31699115
Int J Radiat Oncol Biol Phys. 2015 Dec 1;93(5):989-96
pubmed: 26581137
Chest. 1999 Dec;116(6 Suppl):480S-485S
pubmed: 10619514
CA Cancer J Clin. 2020 Jan;70(1):7-30
pubmed: 31912902
AJR Am J Roentgenol. 2012 Sep;199(3):W322-30
pubmed: 22915422
J Radiat Res. 2020 Jul 6;61(4):586-593
pubmed: 32383730
Int J Radiat Oncol Biol Phys. 2017 Jul 15;98(4):900-907
pubmed: 28258887
Radiother Oncol. 2010 Jan;94(1):1-11
pubmed: 20074823
J Thorac Cardiovasc Surg. 2010 Aug;140(2):377-86
pubmed: 20400121
J Thorac Oncol. 2007 Jul;2(7 Suppl 3):S94-100
pubmed: 17603311
Int J Radiat Oncol Biol Phys. 2016 Jul 15;95(4):1226-35
pubmed: 27209498
Clin Oncol (R Coll Radiol). 2014 Nov;26(11):713-9
pubmed: 25085765
J Cancer Res Clin Oncol. 2020 May;146(5):1263-1271
pubmed: 32095885
Ann Transl Med. 2020 Sep;8(18):1133
pubmed: 33240982
Jpn J Clin Oncol. 2017 Jan 9;47(3):277-281
pubmed: 28073946
J Clin Oncol. 2009 Jun 10;27(17):2758-65
pubmed: 19403886
Eur J Cardiothorac Surg. 2011 Jun;39(6):989-94
pubmed: 21276728
Curr Opin Oncol. 2007 Mar;19(2):84-91
pubmed: 17272978
Int J Radiat Oncol Biol Phys. 2009 Oct 1;75(2):343-7
pubmed: 19735861
Chest. 2011 Oct;140(4):874-880
pubmed: 21436251
Chest. 2003 Nov;124(5):1946-55
pubmed: 14605072
J Geriatr Oncol. 2017 Sep;8(5):351-355
pubmed: 28739159
PLoS One. 2015 Jun 25;10(6):e0131373
pubmed: 26110775
BMC Pulm Med. 2018 Aug 3;18(1):127
pubmed: 30075770
Thorac Cancer. 2016 Jul;7(4):442-51
pubmed: 27385987
Int J Radiat Oncol Biol Phys. 2013 Jun 1;86(2):257-63
pubmed: 23570699
Ann Oncol. 2010 May;21 Suppl 5:v103-15
pubmed: 20555058
Int J Radiat Oncol Biol Phys. 2014 Nov 1;90(3):603-11
pubmed: 25052562