Stereotactic body radiation therapy versus no treatment for early stage non–small cell lung cancer in medically inoperable elderly patients: A National Cancer Data Base analysis

Nanda, Ronica H.; Liu, Yuan; Gillespie, Theresa W.; Mikell, J.L.; Ramalingam, Suresh S.; Fernández, Félix G.; Lipscomb, Joseph; Higgins, Kristin

doi:10.1002/cncr.29640

Cited by 89 publications

(50 citation statements)

References 27 publications

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“…Other retrospective literature examining lung SBRT in older patients includes a database analysis examining 3147 patients ≥70 years old where 96 of the 258 patients treated with SBRT were ≥80 years old. 27 The authors found that SBRT had improved OS versus observation (HR, 0.64). In a recent series by Mancini et al, examining 251 patients treated with lung SBRT, they dichotomized patients at age 75.…”

Section: Discussionmentioning

confidence: 98%

Stereotactic Body Radiotherapy for Early-stage Non–small-cell Lung Cancer in Patients 80 Years and Older: A Multi-center Analysis

Cassidy

Patel

Zhang

et al. 2017

Clinical Lung Cancer

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Stereotactic body radiotherapy (SBRT) for early-stage non–small-cell lung cancer use is evolving, with implementation in a rising geriatric oncologic population. Our study investigated the use of SBRT for non–small-cell lung cancer in 58 consecutive patients ≥ 80 years old at 4 academic centers. SBRT was well-tolerated with expected toxicity rates, excellent disease-specific outcomes, and patients with higher performance status deriving the greatest benefit. Background Stereotactic body radiotherapy (SBRT) is the standard of care for medically inoperable early-stage non– small-cell lung cancer. Despite the limited number of octogenarians and nonagenarians on trials of SBRT, its use is increasingly being offered in these patients, given the aging cancer population, medical fragility, or patient preference. Our purpose was to investigate the efficacy, safety, and survival of patients ≥80 years old treated with definitive lung SBRT. Methods Patients who underwent SBRT were reviewed from 2009 to 2015 at 4 academic centers. Patients diagnosed at ≥80 years old were included. Kaplan-Meier and multivariate logistic regression and Cox proportional hazard regression analyses were performed. Recursive partitioning analysis was done to determine a subgroup of patients most likely to benefit from therapy. Results A total of 58 patients were included, with a median age of 84.9 years (range, 80.1-95.2 years), a median follow-up time of 19.9 months (range, 6.9-64.9 months), a median fraction size of 10.0 Gy (range, 7.0-20.0 Gy), and a median number of fractions of 5.0 (range, 3.0-8.0 fractions). On multivariate analysis, higher Karnofsky performance status (KPS) was associated with higher local recurrence-free survival (hazard ratio [HR], 0.92; P < .01), regional recurrence-free survival (HR, 0.94; P < .01), and overall survival (HR, 0.91; P < .01). On recursive partitioning analysis, patients with KPS ≥75 had improved 3-year cancer-specific and overall survival (99.4% and 91.9%, respectively) compared with patients with KPS < 75 (47.8% and 23.6%, respectively; P < .01). Conclusion Definitive lung SBRT for early-stage non–small-cell lung cancer was efficacious and safe in patients ≥80 years old. Patients with a KPS of ≥75 derived the most benefit from therapy.

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Section: Discussionmentioning

confidence: 98%

Stereotactic Body Radiotherapy for Early-stage Non–small-cell Lung Cancer in Patients 80 Years and Older: A Multi-center Analysis

Cassidy

Patel

Zhang

et al. 2017

Clinical Lung Cancer

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“…The mean PTV of the FF and FFF groups was 50. 4 2), respectively. There were no significant differences between PTV and ITV (P=0.32, 0.64), respectively.…”

Section: Patientsmentioning

confidence: 99%

“…However, not all early-stage NSCLC patients are suited for surgery because of advanced age, patient refusal, or other reasons (3,4). Stereotactic body radiotherapy (SBRT) has been widely used as an effective alternative treatment for primary lung tumors, and reports excellent 3-year progression-free survival (PFS) of up to 90%, which is considerably better than past data with conventional radiotherapy (5,6).…”

Section: Introductionmentioning

confidence: 99%

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Flattening filter-free technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy: A clinical comparison with the flattening filter technique

et al. 2018

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Abstract. The present study sought to evaluate the impact of the flattening filter-free (FFF) technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy. Its clinical safety and availability were compared with the flattening filter (FF) method. The cases of 65 patients who underwent lung volumetric modulated arc therapy-stereotactic body radiotherapy (VMAT-SBRT) using FF or FFF techniques were reviewed. A total of 55 Gy/4 fractions (fr) was prescribed for peripheral lesions or 56 Gy/7 fr for central lesions. The total monitor units (MU), treatment time, dose to tumors, dose to organs at risk, tumor control (local control rate, overall survival, progression-free survival) and adverse events between cases treated with FF and cases treated with the FFF technique were compared. A total of 35 patients were treated with conventional FF techniques prior to November 2014 and 30 patients were treated with FFF techniques after this date. It was revealed that the beam-on time was significantly shortened by the FFF technique (P<0.01). Other factors were similar for FFF and FF plans in respect to conformity (P=0.95), homogeneity (P=0.20) and other dosimetric values, including total MU and planning target volume/internal target volume coverage. The median follow-up period was 18 months (range, 2-35). One-year local control rates were 97.1 and 90.0% in the FF group and FFF groups, respectively (P=0.33). Grade 3 pneumonitis was observed in 5.8% of FF patients and 3.4% of FFF patients (P=1.00). No other adverse events ≥grade 3 were observed. The results of the study suggest that VMAT-SBRT using the FFF technique shortens the treatment time for lung SBRT while maintaining a high local control rate with low toxicity.

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“…3 Another report suggested that SBRT should be used for the treatment of elderly patients with early-stage NSCLC who are unable to tolerate surgical resection due to comorbid conditions. 21 Furthermore, recent study showed that the treatment outcomes of SBRT are not different from that of surgical operation in patients with stage I NSCLC. 22 Accordingly, SBRT can be a most relevant treatment for patients in stage I NSCLC.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Semiautomatic CT Volumetry in Patients With Stage I Non–Small Cell Lung Cancer Treated With Stereotactic Body Radiation Therapy

Satoh

Nambu²,

Saito³

et al. 2016

Journal of Computer Assisted Tomography

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Stereotactic body radiation therapy versus no treatment for early stage non–small cell lung cancer in medically inoperable elderly patients: A National Cancer Data Base analysis

Cited by 89 publications

References 27 publications

Stereotactic Body Radiotherapy for Early-stage Non–small-cell Lung Cancer in Patients 80 Years and Older: A Multi-center Analysis

Stereotactic Body Radiotherapy for Early-stage Non–small-cell Lung Cancer in Patients 80 Years and Older: A Multi-center Analysis

Flattening filter-free technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy: A clinical comparison with the flattening filter technique

Prognostic Value of Semiautomatic CT Volumetry in Patients With Stage I Non–Small Cell Lung Cancer Treated With Stereotactic Body Radiation Therapy

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