Stereotactic body radiation therapy (SBRT) for early-stage lung cancer in the elderly

Shinde, Ashwin; Li, Richard; Kim, Jae; Salgia, Ravi; Hurria, Arti; Amini, Arya

doi:10.1053/j.seminoncol.2018.06.002

Cited by 56 publications

(36 citation statements)

References 76 publications

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“…In published reports analyzing SBRT in early stage NSCLC, age is frequently dichotomized with varied cut points for being old. A recent review by Shinde et al [7] reported cut points in 17 studies: 65 years in two studies, 70 years in two studies, 75 years in six studies, 80 years in five studies, 85 years in one study and 90 years in one study. Besides, most studies are small, only four of the studies included more than 100 patients.…”

Section: Discussionmentioning

confidence: 99%

“…SBRT is a convenient treatment and even older patients with NSCLC in poor performance status (PS) can cooperate to the treatment because of the short treatment schedule. Although the survival for untreated patients is poor [5], and the treatment of old patients presents challenges due to, e.g., comorbidity and impaired organ function, several series have demonstrated that old patients may benefit from SBRT as much as younger do [6,7]. However, the studies have most often analyzed the data dichotomized using different ages as the cut point, most often 75, with rather small numbers of older patients [7].…”

Section: Introductionmentioning

confidence: 99%

“…Although the survival for untreated patients is poor [5], and the treatment of old patients presents challenges due to, e.g., comorbidity and impaired organ function, several series have demonstrated that old patients may benefit from SBRT as much as younger do [6,7]. However, the studies have most often analyzed the data dichotomized using different ages as the cut point, most often 75, with rather small numbers of older patients [7]. Even though SBRT now is an accepted treatment modality, it is unknown if all patients have the same benefit of the treatment due to the lack of randomized studies.…”

Section: Introductionmentioning

confidence: 99%

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Survival after stereotactic radiotherapy in patients with early-stage non-small cell lung cancer

et al. 2019

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Introduction: Stereotactic radiotherapy (SBRT) is the treatment of choice for inoperable early stage non-small cell lung cancer (NSCLC). We report analyses of the influence of age on survival after SBRT. Methods and material: From 2005 to 2017, 544 previously un-irradiated patients with early stage NSCLC had SBRT. The data were analyzed in four age groups: A:-69 (176 pts), B: 70-74 (115 pts), C: 75-79 (131 pts) and D: 80 years or older (122 pts). Two SBRT dose regimes were used: 45 Gy/3F (N ¼ 103) and 66 Gy/3F (N ¼ 441). Results: All patients had a follow up (time to censoring, FU) of at least 16 months, the median FU being 48.0 months. The median age was 74.4 years. The overall survival (OS) was associated with age. The median OS was 50.7, 45.9, 45.4 and 33.0 months, and the 5-year OS was 45%, 32%, 33% and 18% in groups A, B, C and D, respectively. No difference was found between groups B and C, while OS in group A was significantly better than remaining groups, and the OS in group D significantly poorer. In multivariable analyses, OS was heavily influenced by age, Charlson's comorbidity index (CCI) and performance status (PS). For lung cancer-specific survival (LCSS), only increasing tumor diameter and PS were associated with poor survival. Conclusions: The OS was influenced by age, but the study suggests that a cut point of 75 year is inappropriate in evaluating the effect of old age on survival.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Survival after stereotactic radiotherapy in patients with early-stage non-small cell lung cancer

et al. 2019

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“…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.…”

Section: Stereotactic Body Radiotherapy (Sbrt)mentioning

confidence: 91%

Immunomodulatory Effects of Radiotherapy

Kumari

Mukherjee

Sinha

et al. 2020

IJMS

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Radiation therapy (RT), an integral component of curative treatment for many malignancies, can be administered via an increasing array of techniques. In this review, we summarize the properties and application of different types of RT, specifically, conventional therapy with x-rays, stereotactic body RT, and proton and carbon particle therapies. We highlight how low-linear energy transfer (LET) radiation induces simple DNA lesions that are efficiently repaired by cells, whereas high-LET radiation causes complex DNA lesions that are difficult to repair and that ultimately enhance cancer cell killing. Additionally, we discuss the immunogenicity of radiation-induced tumor death, elucidate the molecular mechanisms by which radiation mounts innate and adaptive immune responses and explore strategies by which we can increase the efficacy of these mechanisms. Understanding the mechanisms by which RT modulates immune signaling and the key players involved in modulating the RT-mediated immune response will help to improve therapeutic efficacy and to identify novel immunomodulatory drugs that will benefit cancer patients undergoing targeted RT.

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“…In addition, lymph node metastasis is rare, like it is in patients with T1 NSCLC. A growing number of T1N0 NSCLC patients are nowadays treated with stereotactic body radiation (SBRT) [60,61]. In these patients surgical lymph node staging, like in EBT for carcinoid, is lacking.…”

Section: Discussionmentioning

confidence: 99%

Endobronchial and surgical treatment of pulmonary carcinoid tumors: A systematic literature review

et al. 2019

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A B S T R A C TThe treatment of pulmonary carcinoid has changed over the last decades. Although surgical resection is still the gold standard, minimally invasive endobronchial procedures have emerged as a parenchyma sparing alternative for tumors located in the central airways. This review was performed to identify the optimal treatment strategy for pulmonary carcinoid, with a particular focus on the feasibility and outcome of parenchyma sparing techniques versus surgical resection. A systematic review of the literature was carried out using MEDLINE, Embase and the Cochrane databases, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Two separate searches of publications in endobronchial and surgical treatment in patients with pulmonary carcinoid, were performed. Outcomes were overall survival, disease free survival, recurrence rate, complications, quality of life, and healthcare costs. Combining the two main searches for endobronchial therapy and surgical therapy yielded 3111 records. Finally, 43 studies concerning surgical treatment and 9 studies related to endobronchial treatment for pulmonary carcinoid were included. Assessment of included studies showed that lymph node involvement, histological grade, tumor location and tumor diameter were identified as poor prognostic factors and seem to be important for patients with pulmonary carcinoid. For patients with a more favorable prognosis, tumor location and tumor diameter are important factors that can help decide on the optimal treatment strategy. Centrally located small intraluminal pulmonary carcinoids, without signs of metastasis can be treated with minimally invasive alternatives such as endobronchial treatment or parenchyma sparing surgical resection. Patients with parenchyma sparing resections should be followed with long term follow up to exclude recurrence of disease. In a multidisciplinary setting, it should be determined whether individual patients are eligible for parenchyma sparing procedures or anatomical resection. Overall evidence is of low quality and future studies should focus on prospective trials in the treatment of pulmonary carcinoid.

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Stereotactic body radiation therapy (SBRT) for early-stage lung cancer in the elderly

Cited by 56 publications

References 76 publications

Survival after stereotactic radiotherapy in patients with early-stage non-small cell lung cancer

Survival after stereotactic radiotherapy in patients with early-stage non-small cell lung cancer

Immunomodulatory Effects of Radiotherapy

Endobronchial and surgical treatment of pulmonary carcinoid tumors: A systematic literature review

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