around 80%. In elderly patients SBRT represents an alternative and competitive option since many of them might have age-associated comorbidities that make them unsuitable for surgery The aim of this study is to assess the clinical results in terms of local control, toxicity and failure pattern of lung SBRT in patients 75 years old or more with lung oligometases of any origin treated at our institution. Method: Retrospective review of the medical records of 43 lung metastases in 28 consecutive elderly patients treated with SBRT between 2003 and 2017. One to four of inoperable (sinchronous or metachronic) metastatic lesions were treated per patient. SBRT was performed in case of controlled primary tumor, long-term of progression disease, exclusion of surgery, and number of metastatic sites 5. Toxicity and radiologic response were assessed in follow-up visits, using standardized criteria and analyzed retrospectively. SBRT involved: computed tomography (CT) simulation with immobilization devices, contouring the target volume in 3 sets of CTs, superimposing the volumes in the planning system to represent the internal target volume and dose calculation using heterogeneity correction. Radiation delivery with multiple static non-coplanar beams and arc therapy assured conformal dose distribution and steep fall-off of the radiation. The prescribed dose was 3 fractions of 14-16 Gy each or a single 30-Gy fraction. Dosimetric constraints were set for surrounding organs at risk. Result: The median age was 79 years (75-87). Primary tumor was lung cancer in 44% of patients, colorectal cancer in 23% and a variety of other origins in 33%. After a median follow-up time of 15.3 months, the 1 and 2 year actuarial local control rates for all treated lesions were 95 and 91 %, respectively. Overall survival at 1 and 2 years was 86.7 and 60.4 %. Cancer-specific survival was 95.3 and 75.2 %, respectively. Treatmentrelated grade 1-2 toxicity was observed in 8 %. There were no grade 3-4 toxicity. Conclusion: In our experience, elderly patients with pulmonary metastases treated with SBRT achieved excellent local control and promising overall survival. SBRT is a safe local treatment option even in fragile patients with multiple comorbidities/low functional reserve, given its very low morbidity and excellent tolerability. Since main failure pattern is distant progression, there is room for improved clinical selection of most adequate candidates and optimization of systemic treatment.

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