Stereotactic body radiotherapy for single and multiple early-stage non-small cell lung cancer in patients aged ≥ 80 years.

Abstract

Background: Lung cancer primarily affects elderly individuals and is the leading cause of cancer-related death in people aged 80 years and older. In addition, the incidence of multiple primary lung cancer (MPLC) is increasing worldwide. Although surgery is recommended as the standard of care, many elderly patients are considered medically unsuitable, or they refuse surgery. The role of stereotactic body radiotherapy (SBRT) as an alternative treatment option for these elderly patients, particularly those with multiple primary lung cancer, has not been fully elucidated. Therefore, the aim of this study was to report the outcome and toxicities associated with SBRT for histologically confirmed early-stage non-small cell lung cancer (NSCLC) and synchronous and metachronous multiple primary lung cancer in patients aged ≥ 80 years.

Methods: This retrospective study included 118 patients aged ≥ 80 years with a total of 141 SBRT-treated primary lung cancers (19 patients with MPLC). We assessed local control (LC), progression-free survival (PFS), overall survival (OS) and cancer-specific survival (CSS). We further evaluated toxicities and factors impacting therapeutic efficacy.

Results: The median follow-up after SBRT was 47 months (range 3-169 months). The LC rate was 96.2% (95% CI: 90.1 to 98.6%) two years and 86.4% (71.8 to 93.8%) five years after SBRT for NSCLC/MPLC. The PFS and OS rates were 67.0% (57.4 to - 74.9%) and 74.7% (65.4 to - 81.1%), respectively, after two years and 24.7% (14.5 to 35.6%) and 30.2% (19.4 to 41.7%), respectively, after five years. The CSS rate was 88.6% (80.3-93.6%) at two years and 76.6% (61.4-86.4%) at 5 years after SBRT. Age and the Charlson Comorbidity Index score were found to be independent predictors of OS and PFS. Predictors other than these patient-related factors could not be identified. Toxicities higher than Grade 2 after SBRT of NSCLC and MPLC were not observed.

Conclusion: This study emphasises the efficacy and safety of SBRT in the treatment of early-stage NSCLC in patients aged ≥ 80 years, including those with MPLC. SBRT proves to be an appropriate treatment modality for this frail patient group, as it provides favourable LC and CSS rates with low toxicity.