Is surgery indicated for elderly patients with early stage nonsmall cell lung cancer, in the era of stereotactic body radiotherapy?

Abstract

Background:The aim of this article is to assess the influence of comorbidities among elderly patients (at least 70 year old) undergoing surgery for early stage nonsmall cell lung cancer (NSCLC) and to explore the tolerability and efficacy of surgery in relation to stereotactic body radiotherapy (SBRT) in this patient population.Methods:A review of the literature on the prevalence of comorbidities among elderly patients with early stage NSCLC, and the impact of comorbidity factors on survival following surgery was conducted. Survival rates and the incidence of complications following SBRT for this patient population were also identified.Results:Comorbidities in elderly patients with early stage NSCLC may preclude surgery or lead to poor survival following surgery. However, chronological age alone should not be used as a deciding factor to deny curative treatment in elderly, but fit patients. Stereotactic body radiotherapy is well tolerated by elderly lung cancer patients and may result in survival rates similar to that following surgery.Conclusion:SBRT should be the treatment of choice for early stage NSCLC in elderly patients with multiple comorbidities that preclude surgery. The roles of surgery and SBRT for elderly, -fit patients with early stage NSCLC needs to be further defined in future prospective trials.

Challenges Facing Radiation Oncologists in The Management of Older Cancer Patients: Consensus of The International Geriatric Radiotherapy Group

“…While historically it may be true, radiation oncology has evolved significantly over the past 20 years due to advances in imaging and radiotherapy techniques. This allows precise targeting of the tumor to a high dose and thus potential cure despite the presence of multiple co-morbidity factors [6]. As a result, radiation oncologists often face difficult treatment decisions on how to provide the best treatment to a growing segment of the population when they have to strike a delicate balance of choosing between treatment toxicity versus potential cure.…”

“…A course of curative radiotherapy may last for six to eight weeks and may potentially affect an older patient’s quality of life (QOL) because of their limited mobility [11,12]. Those issues need to be addressed to provide potential solutions which may improve quality of care for older cancer patients, such as hypofractionated and stereotactic body radiation [6,13,14].…”

WDR79 mediates the proliferation of non‐small cell lung cancer cells by regulating the stability of UHRF1

“…Lung cancer is the disease with the highest morbidity and mortality rate in the world 1. In 2017, it has been estimated that lung cancer will account for 13% of all new cancer cases and for 26% of cancer‐related deaths 2.…”

Efficacy and safety of image-guidance radiotherapy by helical tomotherapy in patients with lung cancer

“…[ 9 – 13 ] It utilized advanced imaging techniques to deliver a targeted radiation dose to a tumor with a high degree of precision and steep dose gradients. [ 9 – 10 ] Additionally, it can also minimize the dose to normal tissues, which can help preserve the healthy tissue for patients with lung cancer. It has been reported that IGSBR for the treatment of lung cancer achieved excellent effect of local control rates for primary tumors, and metastatic malignancies.…”