Stereotactic Body Radiotherapy in Octo- and Nonagenarians for the Treatment of Early Stage Lung Cancer

Publication date: Available online 9 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Meredith Giuliani, Andrew Hope, Matthias Guckenberger, Frederick Mantel, Heike Peulen, Jan-Jakob Sonke, José Belderbos, Maria Werner-Wasik, Hong Ye, Inga S. Grills
PurposeTo determine the safety and efficacy of lung SBRT in Octo- and Nonagenarians and to compare their outcomes to those of younger patients.MethodsPatients with primary lung cancer treated with SBRT were identified from a multi-institutional (5) database of 1083 cases. Details of patient factors, treatment specifics, toxicity and clinical outcomes were extracted from the database. All events were calculated from the end of radiotherapy. Estimates of local recurrence (LR), regional recurrence (RR), and distant metastases (DM) were calculated using the competing risk method. Cause specific (CSS) and overall survival (OS) were calculated using the Kaplan-Meier method. Outcomes were compared for those aged <70, 70-79, ≥80. Univariable (UVA) and multivariable analyses (MVA) was performed to determine associations with CSS and OS in patients aged ≥80.ResultsThe median follow-up was 1.7 years (1-10y) and median age 75 (41-94). There were 305 patients age <70 (28%), 448 age 70-79 (41%) and 330 age ≥80 (30%). There was no difference in 2 year LR (4.2% vs 5.4% vs 3.7%, p=0.7), RR (10.4% vs. 7.8% vs 5.3%, p=0.1), DM (12.2% vs 7.7% vs 9.5%, p=0.2) or CSS (90.6% vs 90.3% vs. 90.4%, p=0.6). Those age ≥80 had significantly lower 2 year OS (73.6% vs 67.2% vs 63.3%, p<0.01). The grade 3+ pneumonitis rate was 1.3% vs 1.6% vs 1.5% (p=1.0) in patients ages <70,70-79, ≥80 respectively. The 90 day mortality rates for patients aged <70, 70-79, ≥80 were 1.3%, 2.5%, and 2.4% (P=0.01) respectively. In patients aged ≥80 OS was associated with T-Category (HR1.7; P<0.01).ConclusionSBRT is a safe treatment modality in elderly patients (aged ≥80). Despite larger tumor volumes, the tumor control outcomes were comparable to the younger patients treated with SBRT. All patients with early stage lung cancer, regardless of age, should be considered for treatment o with SBRT.

Teaser

This manuscript explored the safety and efficacy of lung SBRT in Octo- and Nonagenarians. In 1083 patients there were 330 patients age ≥80. Older patients had comparable local, regional and distant control and rates of toxicity to younger patients. Overall survival was significantly lower at 2 years in patients age ≥80. All patients with early stage lung cancer, regardless of age, should be considered for treatment o with SBRT.


http://ift.tt/2j104Az