Stereotactic body radiotherapy for very elderly patients (age, greater than or equal to 85 years) with stage I non-small cell lung cancer

Radiation Oncology, Jun 2014

Background Stereotactic body radiotherapy (SBRT) for non-small cell lung cancer (NSCLC) is primarily a treatment option for medically inoperable patients, who are often elderly. However, few studies report the effects of SBRT in elderly patients. Thus, we retrospectively analyzed clinical outcomes and feasibility following treatment of very elderly patients (age ≥ 85 years) with stage Ι NSCLC and younger patients (age < 85 years) with SBRT in our institution. Methods From January 2006 to December 2012, 81 patients (20 very elderly; median age, 80 years; age range 64–93 years) with stage Ι NSCLC received SBRT. Prescription doses of 48 Gy were delivered in 4 fractions over 2 weeks or doses of 60 Gy were delivered in 10 fractions over 3 weeks. Results Local control was achieved in 91.8% of all patients at 3 years (83.1% and 93.8% of very elderly and younger patients, respectively), and the 3-year overall survival (OS) rate was 69.4% (40.7% and 75.0% of very elderly and younger patients, respectively). OS rates were significantly shorter for the very elderly group than for the younger group, with a 3-year cause-specific survival (CSS) rate of 77.9% (50.4% and 81.6% of very elderly and younger patients, respectively) and a 3-year progression-free survival (PFS) rate of 59.5% (44.7% and 63.5% in very elderly and younger groups, respectively). Multivariate analysis revealed a significant correlation between T stage and OS. Grades 2 and 3 radiation pneumonitis (RP) occurred in 7 (8.6%) and 2 (2.5%) patients, respectively. Among patients of very elderly and younger groups, grade 2 RP occurred in 4 (20%) and 3 (4.9%) patients, and grade 3 occurred in 2 (10%) and 0 (0%) patients, respectively. No grade 4 or 5 toxicity was observed, RP was significantly more severe among very elderly patients. Conclusions SBRT for stage Ι NSCLC was well tolerated and feasible in very elderly patients. The efficacy of SBRT was comparable to that achieved in younger patients, although very elderly patients experienced significantly more severe RP. Although this study cohort included only 20 very elderly patients, the present data suggest that decreasing volumes of normal lung tissues exposed to ≥ 20 Gy and mean lung doses reduces the risk of RP in very elderly patients. The present data warrant studies of larger very elderly cohorts.

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Stereotactic body radiotherapy for very elderly patients (age, greater than or equal to 85 years) with stage I non-small cell lung cancer

Radiation Oncology Stereotactic body radiotherapy for very elderly patients (age, greater than or equal to 85 years) with stage I non-small cell lung cancer Shinya Hayashi 0 Hidekazu Tanaka 1 Yuuichi Kajiura Yasushi Ohno Hiroaki Hoshi 0 0 Department of Radiology, Gifu University Graduate School of Medicine , Yanagido 1-1, Gifu 501-1194 , Japan 1 Department of Radiology , Gifu Background: Stereotactic body radiotherapy (SBRT) for non-small cell lung cancer (NSCLC) is primarily a treatment option for medically inoperable patients, who are often elderly. However, few studies report the effects of SBRT in elderly patients. Thus, we retrospectively analyzed clinical outcomes and feasibility following treatment of very elderly patients (age 85 years) with stage NSCLC and younger patients (age < 85 years) with SBRT in our institution. Methods: From January 2006 to December 2012, 81 patients (20 very elderly; median age, 80 years; age range 64-93 years) with stage NSCLC received SBRT. Prescription doses of 48 Gy were delivered in 4 fractions over 2 weeks or doses of 60 Gy were delivered in 10 fractions over 3 weeks. Results: Local control was achieved in 91.8% of all patients at 3 years (83.1% and 93.8% of very elderly and younger patients, respectively), and the 3-year overall survival (OS) rate was 69.4% (40.7% and 75.0% of very elderly and younger patients, respectively). OS rates were significantly shorter for the very elderly group than for the younger group, with a 3-year cause-specific survival (CSS) rate of 77.9% (50.4% and 81.6% of very elderly and younger patients, respectively) and a 3-year progression-free survival (PFS) rate of 59.5% (44.7% and 63.5% in very elderly and younger groups, respectively). Multivariate analysis revealed a significant correlation between T stage and OS. Grades 2 and 3 radiation pneumonitis (RP) occurred in 7 (8.6%) and 2 (2.5%) patients, respectively. Among patients of very elderly and younger groups, grade 2 RP occurred in 4 (20%) and 3 (4.9%) patients, and grade 3 occurred in 2 (10%) and 0 (0%) patients, respectively. No grade 4 or 5 toxicity was observed, RP was significantly more severe among very elderly patients. Conclusions: SBRT for stage NSCLC was well tolerated and feasible in very elderly patients. The efficacy of SBRT was comparable to that achieved in younger patients, although very elderly patients experienced significantly more severe RP. Although this study cohort included only 20 very elderly patients, the present data suggest that decreasing volumes of normal lung tissues exposed to 20 Gy and mean lung doses reduces the risk of RP in very elderly patients. The present data warrant studies of larger very elderly cohorts. Stereotactic body radiotherapy; Non-small cell lung cancer; Elderly patients; Radiation pneumonitis - Background Numbers of elderly patients with non-small cell lung cancer (NSCLC) are currently increasing [1]. However, these patients are less likely to receive surgical resection due to comorbid conditions, higher intraoperative risks, and personal preference to avoid definitive surgery. Radiotherapy offers a curative alternative for elderly patients with NSCLC, although conventional radiotherapy is not curative [2]. Silbley GS et al. showed that higher than conventional doses of radiotherapy improved survival in patients with medically inoperable stage I NSCLC [3]. Furthermore, stereotactic body radiotherapy (SBRT) presents a promising treatment for patients with stage I NSCLC who are medically inoperable or refuse surgery, with improved efficacy and lower complication rates [4-7]. Previously, the effectiveness of lobectomy, sublobar resection, conventional radiotherapy, SBRT, and observation based treatment strategies were compared with conventional radiotherapy in elderly patients. In this study, overall survival (OS) was significantly improved following SBRT and was similar to that after lobectomy [8]. Other recent reports also indicate that SBRT is an effective treatment option for the elderly (age 75 years), with minimal toxicity [9-12] and similar OS outcomes to those achieved with surgery [13]. According to reports from Japanese institutions, SBRT is primarily performed in medically inoperable NSCLC patients with median ages of 7678 years [14-17]. Japan has one of the worlds fastest aging societies, with a mean life expectancy at birth of 83 years in 2011 (79 years for men and 86 years for women) [18]. However, few studies report outcomes of SBRT in elderly patients with NSCLC. Thus, in the present study, we retrospectively analyzed clinical outcomes and feasibility of SBRT in 20 very elderly patients (85 years) with stage NSCLC who exceeded the Japanese life expectancy at birth, and made comparisons with NSCLC patients of < 85 years. Methods Eligibility criteria Eligibility criteria were as follows: (1) identification of T1N0M0 or T2aN0M0 (stage ) primary lung cancer according to the Union for International Cancer Cont (...truncated)


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Shinya Hayashi, Hidekazu Tanaka, Yuuichi Kajiura, Yasushi Ohno, Hiroaki Hoshi. Stereotactic body radiotherapy for very elderly patients (age, greater than or equal to 85 years) with stage I non-small cell lung cancer, Radiation Oncology, 2014, pp. 138, 9, DOI: 10.1186/1748-717X-9-138