Stereotactic Ablative Radiotherapy is a Highly Effective Treatment for Early Stage Non-Small Cell Lung Cancer in Elderly Patients

Purpose—To discern the efficacy and toxicity of SABR in the elderly population (age ≥75), and to consider how it compares to surgical outcomes historically reported in the elderly. Methods and Materials—772 patients with clinically early-stage I-II NSCLC (T1-T3 N0M0) were treated with SABR (50 Gy in 4 fractions or 70 Gy in 10 fractions) between 2004-2014 at our center (n=442 age <75, n=330 age ≥75). Primary end points included overall survival, progressionfree survival, and grade ≥3 toxicity. Median follow-up time was approximately 55 months. Results—Compared to patients age <75, patients age ≥75 had no difference in progression free survival (p=0.419), lung cancer-specific survival (p=0.275), or toxicity (p=0.536). Overall survival was the same between both age groups at 2-years of follow-up but diverged thereafter, with patients aged <75 when treatment began having higher overall survival rates at 5 years. Median OS rates for patients age ≥75 were 86% at 1 year, 57.5% at 2 years, and 39.5% at 5 years. No patient ≥75 experienced any grade 4 or 5 toxicity. Conclusions—SABR’s effectiveness based on lung cancer-specific survival and progressionfree survival is the same in the elderly as it is the average age population. It also poses no increased toxicity. Compared to historical outcomes with surgery in the elderly, SABR outcomes here are considered comparable for stage I-II disease but have less morbidity. Corresponding author: Joe Y Chang, MD, PhD, Department of Radiation Oncology, Unit 1422, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030-4008. Tel 713-563-2337; jychang@mdanderson.org. Conflicts of interest: Please refer to COI disclosures. HHS Public Access Author manuscript Int J Radiat Oncol Biol Phys. Author manuscript; available in PMC 2018 April 03. Published in final edited form as: Int J Radiat Oncol Biol Phys. 2017 July 15; 98(4): 900–907. doi:10.1016/j.ijrobp.2016.12.022. A uhor M anscript

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