Lung stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer in the very elderly (≥ 80 years old): Extremely safe and effective

Immunomodulatory Effects of Radiotherapy

“…Patients with inoperable NSCLC who received SBRT had better 3-year overall survival with better local tumor control than patients who were treated with conventional RT [10]. SBRT in older adults with early stage lung cancer showed the same trend [12,13]. In some studies, patients treated with SBRT for bone metastases in oligometastatic prostate carcinoma [14], hepatocellular carcinoma [15], prostate cancer [16,17], head and neck cancer [18], and pancreatic cancer [19] also showed better outcomes than patients who received conventional RT.…”

“…Longer survival than SBRT, spares more normal liver cells from radiation damage than treating with conventional RT [39][40][41] Esophageal Proton vs. IMRT Randomized Phase II The mean total toxicity burden was considerably lower with protons than with IMRT [42] Brain (Adult) Proton Trial study unknown Significantly reduced the side effects and better neurocognition over time after treatment [43][44][45][46] Brain (Pediatric) Proton vs. Photon Trial study unknown Spared more surrounding normal tissue; reduced side effects and increased five-year survival rates (72-100%) [32,[47][48][49][50] Safer to deliver high dose of radiation and better neurocognition [44][45][46]51] 2.3.2. Carbon Ion Therapy 12 C ions are the optimal ion for treating deep-seated tumors, because the higher relative biological effectiveness (RBE) resulting from variations in linear energy transfer (LET) along the ion path can be limited to the tumor volume with minimal normal tissue injury along the entrance track. In addition to their favorable RBE characteristics, 12 C ions offer minimal lateral and longitudinal scattering-one-third that of protons-and the potential to use in-line positron emission tomography (PET) for dose deposition verification and mapping.…”

“…Carbon Ion Therapy 12 C ions are the optimal ion for treating deep-seated tumors, because the higher relative biological effectiveness (RBE) resulting from variations in linear energy transfer (LET) along the ion path can be limited to the tumor volume with minimal normal tissue injury along the entrance track. In addition to their favorable RBE characteristics, 12 C ions offer minimal lateral and longitudinal scattering-one-third that of protons-and the potential to use in-line positron emission tomography (PET) for dose deposition verification and mapping. Furthermore, 12 C ions' higher RBE will probably make them more efficacious against radioresistant tumors, and hypoxic tumors will probably also respond better to high-LET radiation than to megavoltage RT or protons.…”

Real-world treatment patterns for patients 80 years and older with early lung cancer: a nationwide claims study

“…A multicenter study reported that grade 2 radiation pneumonitis (RP) developed in 34.5% of patients and non-RP related toxicity was reported in 12.1%; however, no grade 4 or 5 toxicity was reported in the group who underwent SBRT for early-stage lung cancer (median age, 84.9 years) [ 21 ]. Another study regarding the safety of definitive SBRT in patients more than 80 years old suggested its high efficacy and tolerability [ 11 ]. Of interest, a prior study that investigated the effectiveness of SBRT at a single center reported that the OS rates for patients over 75 years were 86% at 1 year, 57.5% at 3 years, and 39.5% at 5 years [ 22 ], which is comparable to the survival rates of 79.1% at 1 year, 61.3% at 3 years, and 32.4% at 5 years in our patients who underwent SBRT.…”

“…The excellent local control and lower complication rates of SBRT may lead to changes in practical treatment patterns in patients with early-stage lung cancer who are not suitable for surgery or refuse treatment due to concerns over surgical complications. Toxicity issues associated with the treatment of early-stage NSCLC in the elderly remain, although previous studies have suggested that SBRT is safe and tolerable in elderly populations [ 11 ]. A recent study reported that the practice pattern and treatment outcomes have changed in elderly stage I lung cancer patients since the introduction of SBRT in the United States [ 12 ].…”