Top

Journal of Cancer Research and Clinical Oncology

Published in:

01-05-2020 | NSCLC | Original Article – Clinical Oncology

Stereotactic body radiotherapy for elderly patients (≥ 75 years) with early-stage non-small cell lung cancer

Authors: Zekai Shu, Baiqiang Dong, Lei Shi, Wei Shen, Qingqing Hang, Jin Wang, Yuanyuan Chen

Published in: Journal of Cancer Research and Clinical Oncology | Issue 5/2020

Abstract

Purpose

Stereotactic body radiotherapy (SBRT) is the primary treatment method for early-stage non-small cell lung cancer (NSCLC) considered inoperable due to medical comorbidities. However, the application of SBRT in patients aged ≥ 75 years has not been adequately studied. This retrospective study aimed to investigate the effectiveness and safety of SBRT in early-stage NSCLC patients aged ≥ 75 years, and the impact of treatment on nutritional status and self-care ability.

Methods

Histopathologically confirmed early-stage (T1-3N0M0) NSCLC patients aged ≥ 75 years treated with SBRT between 2013 and 2018 at our center were identified from the electronic database. Treatment efficacy, treatment toxicities, impact of treatment on nutritional status, and self-care ability were retrospectively analyzed. Toxicities were evaluated according to the Common Terminology Criteria for Adverse Event (CTCAE) (Common 2010) version 4.0. Nutritional status was assessed by Nutritional Risk Screening 2002 criteria, and self-care ability by Barthel index and fall risk index.

Results

A total of 68 patients were enrolled. Median follow-up duration was 46.3 (3.9–80.1) months. The 1-, 3-, and 5-year overall survival rates were 92.6%, 77.2%, and 59.1%, respectively, and the 1-year, 3-year and 5-year local control rates were 95.6%, 88.9% and 85.6%, respectively. Grade 1–2 and grade 3 radiation pneumonitis occurred in 60/68 (96.8%) and 1/68 (1.5%) patients, respectively. Fall risk at 3 months after treatment was not significantly different from that before treatment (P = 0.22). Barthel index increased significantly after treatment (P < 0.001).

Conclusions

SBRT appears to be effective and safe for NSCLC patients aged ≥ 75 years, with no adverse impact on nutritional status and self-care ability.

Baumann P et al (2009) Outcome in a prospective phase II trial of medically inoperable stage I non-small-cell lung cancer patients treated with stereotactic body radiotherapy. J Clin Oncol 27:3290–3296. https://doi.org/10.1200/jco.2008.21.5681CrossRefPubMed

Berry MF, Onaitis MW, Tong BC, Harpole DH, D'Amico TA (2011) A model for morbidity after lung resection in octogenarians. Eur J Cardio-thoracic Surg 39:989–994. https://doi.org/10.1016/j.ejcts.2010.09.038CrossRef

Bezjak A et al (2019) Safety and efficacy of a five-fraction stereotactic body radiotherapy schedule for centrally located non-small-cell lung cancer: NRG oncology/RTOG 0813 trial. J Clin Oncol 37:1316–1325. https://doi.org/10.1200/jco.18.00622CrossRefPubMedPubMedCentral

Brooks ED et al (2017) Stereotactic ablative radiation therapy is highly safe and effective for elderly patients with early-stage non-small cell lung cancer. Int J Radiat Oncol Biol Phys 98:900–907. https://doi.org/10.1016/j.ijrobp.2016.12.022CrossRefPubMed

Chang JY, Bezjak A, Mornex F (2015) Stereotactic ablative radiotherapy for centrally located early stage non-small-cell lung cancer: what we have learned. J Thorac Oncol 10:577–585. https://doi.org/10.1097/jto.0000000000000453CrossRefPubMed

Chen G et al (2019) Choice of immobilization of stereotactic body radiotherapy in lung tumor patient by BMI. BMC Cancer 19:583. https://doi.org/10.1186/s12885-019-5767-1CrossRefPubMedPubMedCentral

Chi A, Liao Z, Nguyen NP, Xu J, Stea B, Komaki R (2010) Systemic review of the patterns of failure following stereotactic body radiation therapy in early-stage non-small-cell lung cancer: clinical implications. Radiother Oncol 94:1–11. https://doi.org/10.1016/j.radonc.2009.12.008CrossRefPubMed

Crabtree TD et al (2010) Stereotactic body radiation therapy versus surgical resection for stage I non-small cell lung cancer. J Thorac Cardiovasc Surg 140:377–386. https://doi.org/10.1016/j.jtcvs.2009.12.054CrossRefPubMed

Crino L, Weder W, van Meerbeeck J, Felip E (2010) Early stage and locally advanced (non-metastatic) non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 21(Suppl 5):v103–115. https://doi.org/10.1093/annonc/mdq207CrossRefPubMed

Detillon D, Driessen EJM, Aarts MJ, Janssen-Heijnen MLG, van Eijck CHJ, Veen EJ (2018) Changes in treatment patterns and survival in elderly patients with stage I non-small-cell lung cancer with the introduction of stereotactic body radiotherapy and video-assisted thoracic surgery. Eur J Cancer (Oxford England: 1990) 101:30–37. https://doi.org/10.1016/j.ejca.2018.06.016CrossRef

Detillon D, Aarts MJ, De Jaeger K, Van Eijck CHJ, Veen EJ (2019) Video-assisted thoracic lobectomy versus stereotactic body radiotherapy for stage I nonsmall cell lung cancer in elderly patients: a propensity matched comparative analysis. Eur Respir J. https://doi.org/10.1183/13993003.01561-2018CrossRefPubMed

Die Trill M (2012) Psychological aspects of depression in cancer patients: an update. Ann Oncol 23(Suppl 10):x302–305. https://doi.org/10.1093/annonc/mds350CrossRefPubMed

Dominguez-Ventura A, Cassivi SD, Allen MS, Wigle DA, Nichols FC, Pairolero PC, Deschamps C (2007) Lung cancer in octogenarians: factors affecting long-term survival following resection. Eur J Cardio-Thorac Surg 32:370–374. https://doi.org/10.1016/j.ejcts.2007.04.002CrossRef

Dong B et al (2019a) Comparison of the outcomes of stereotactic body radiotherapy versus surgical treatment for elderly (>/=70) patients with early-stage non-small cell lung cancer after propensity score matching. Radiat Oncol (London, England) 14:195. https://doi.org/10.1186/s13014-019-1399-5CrossRef

Dong B et al (2019b) Comparison of the efficacy of stereotactic body radiotherapy versus surgical treatment for early-stage non-small cell lung cancer after propensity score matching. Transl Oncol 12:1032–1037. https://doi.org/10.1016/j.tranon.2019.04.015CrossRefPubMedPubMedCentral

Dutz A, Lock S (2019) Competing risks in survival data analysis. Radiother Oncol 130:185–189. https://doi.org/10.1016/j.radonc.2018.09.007CrossRefPubMed

Eisenhauer EA et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer (Oxford, England: 1990) 45:228–247. 10.1016/j.ejca.2008.10.026

Ezer N, Veluswamy RR, Mhango G, Rosenzweig KE, Powell CA, Wisnivesky JP (2015) Outcomes after stereotactic body radiotherapy versus limited resection in older patients with early-stage lung cancer. J Thorac Oncol 10:1201–1206. https://doi.org/10.1097/jto.0000000000000600CrossRefPubMedPubMedCentral

Ginsberg RJ, Rubinstein LV (1995) Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg 60:615–622. https://doi.org/10.1016/0003-4975(95)00537-u(discussion 622–613)CrossRefPubMed

Grills IS et al (2010) Outcomes after stereotactic lung radiotherapy or wedge resection for stage I non-small-cell lung cancer. J Clin Oncol 28:928–935. https://doi.org/10.1200/jco.2009.25.0928CrossRefPubMed

Grutters JP, Kessels AG, Pijls-Johannesma M, De Ruysscher D, Joore MA, Lambin P (2010) Comparison of the effectiveness of radiotherapy with photons, protons and carbon-ions for non-small cell lung cancer: a meta-analysis. Radiother Oncol 95:32–40. https://doi.org/10.1016/j.radonc.2009.08.003CrossRefPubMed

Haasbeek CJ, Palma D, Visser O, Lagerwaard FJ, Slotman B, Senan S (2012) Early-stage lung cancer in elderly patients: a population-based study of changes in treatment patterns and survival in the Netherlands. Ann Oncol 23:2743–2747. https://doi.org/10.1093/annonc/mds081CrossRefPubMed

Hauffman A, Alfonsson S, Mattsson S, Forslund M, Bill-Axelson A, Nygren P, Johansson B (2017) The development of a nurse-led internet-based learning and self-care program for cancer patients with symptoms of anxiety and depression-a part of U-CARE. Cancer Nurs 40:E9–e16. https://doi.org/10.1097/ncc.0000000000000402CrossRefPubMed

Huang K, Palma DA (2015) Follow-up of patients after stereotactic radiation for lung cancer: a primer for the nonradiation oncologist. J Thorac Oncol 10:412–419. https://doi.org/10.1097/jto.0000000000000435CrossRefPubMed

Hurkmans CW, Cuijpers JP, Lagerwaard FJ, Widder J, van der Heide UA, Schuring D, Senan S (2009) Recommendations for implementing stereotactic radiotherapy in peripheral stage IA non-small cell lung cancer: report from the Quality Assurance Working Party of the randomised phase III ROSEL study. Radiat Oncol (London, England) 4:1. https://doi.org/10.1186/1748-717x-4-1CrossRef

Institute NC Common Terminology Criteria for Adverse Events (CTCAE) (2010) v4.0 https://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm#ctc_40. Accessed June 2019

Kondrup J, Allison SP, Elia M, Vellas B, Plauth M (2003) ESPEN guidelines for nutrition screening 2002. Clin Nutr (Edinburgh, Scotland) 22:415–421CrossRef

Kunkler IH et al (2014) Review of current best practice and priorities for research in radiation oncology for elderly patients with cancer: the International Society of Geriatric Oncology (SIOG) task force. Ann Oncol 25:2134–2146. https://doi.org/10.1093/annonc/mdu104CrossRefPubMed

Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel Index. Md State Med J 14:61–65PubMed

Miao JP et al (2019) Comparison of two malnutrition risk screening tools with nutritional biochemical parameters, BMI and length of stay in Chinese geriatric inpatients: a multicenter, cross-sectional study. BMJ Open 9:e022993. https://doi.org/10.1136/bmjopen-2018-022993CrossRefPubMedPubMedCentral

Nikendei C, Terhoeven V, Ehrenthal JC, Maatouk I, Wild B, Herzog W, Friederich HC (2018) Depression profile in cancer patients and patients without a chronic somatic disease. Psycho-oncology 27:83–90. https://doi.org/10.1002/pon.4465CrossRefPubMed

Nyman J et al (2016) SPACE—a randomized study of SBRT vs conventional fractionated radiotherapy in medically inoperable stage I NSCLC. Radiother Oncol 121:1–8. https://doi.org/10.1016/j.radonc.2016.08.015CrossRefPubMed

Okami J et al (2009) Pulmonary resection in patients aged 80 years or over with clinical stage I non-small cell lung cancer: prognostic factors for overall survival and risk factors for postoperative complications. J Thorac Oncol 4:1247–1253. https://doi.org/10.1097/JTO.0b013e3181ae285dCrossRefPubMed

Osmani L, Askin F, Gabrielson E, Li QK (2018) Current WHO guidelines and the critical role of immunohistochemical markers in the subclassification of non-small cell lung carcinoma (NSCLC): Moving from targeted therapy to immunotherapy. Semin Cancer Biol 52:103–111. https://doi.org/10.1016/j.semcancer.2017.11.019CrossRefPubMed

Palma D, Visser O, Lagerwaard FJ, Belderbos J, Slotman BJ, Senan S (2010) Impact of introducing stereotactic lung radiotherapy for elderly patients with stage I non-small-cell lung cancer: a population-based time-trend analysis. J Clin Oncol 28:5153–5159. https://doi.org/10.1200/jco.2010.30.0731CrossRefPubMed

Palma D, Visser O, Lagerwaard FJ, Belderbos J, Slotman B, Senan S (2011) Treatment of stage I NSCLC in elderly patients: a population-based matched-pair comparison of stereotactic radiotherapy versus surgery. Radiother Oncol 101:240–244. https://doi.org/10.1016/j.radonc.2011.06.029CrossRefPubMed

Paul S, Lee PC, Mao J, Isaacs AJ, Sedrakyan A (2016) Long term survival with stereotactic ablative radiotherapy (SABR) versus thoracoscopic sublobar lung resection in elderly people: national population based study with propensity matched comparative analysis. BMJ (Clinical research ed) 354:i3570. https://doi.org/10.1136/bmj.i3570CrossRef

Perell KL, Nelson A, Goldman RL, Luther SL, Prieto-Lewis N, Rubenstein LZ (2001) Fall risk assessment measures: an analytic review. J Gerontol Ser A Biol Sci Med Sci 56:M761–766. https://doi.org/10.1093/gerona/56.12.m761CrossRef

Poulia KA et al (2017) The two most popular malnutrition screening tools in the light of the new ESPEN consensus definition of the diagnostic criteria for malnutrition. Clin Nutr (Edinburgh, Scotland) 36:1130–1135. https://doi.org/10.1016/j.clnu.2016.07.014CrossRef

Qian H, Yuan C (2012) Factors associated with self-care self-efficacy among gastric and colorectal cancer patients. Cancer Nurs 35:E22–31. https://doi.org/10.1097/NCC.0b013e31822d7537CrossRefPubMed

Shirvani SM et al (2012) Comparative effectiveness of 5 treatment strategies for early-stage non-small cell lung cancer in the elderly. Int J Radiat Oncol Biol Phys 84:1060–1070. https://doi.org/10.1016/j.ijrobp.2012.07.2354CrossRefPubMedPubMedCentral

Shirvani SM et al (2014) Lobectomy, sublobar resection, and stereotactic ablative radiotherapy for early-stage non-small cell lung cancers in the elderly. JAMA Surg 149:1244–1253. https://doi.org/10.1001/jamasurg.2014.556CrossRefPubMedPubMedCentral

Siegel RL, Miller KD, Jemal A (2017) Cancer statistics, 2017. CA Cancer J Clin 67:7–30. https://doi.org/10.3322/caac.21387CrossRefPubMed

Siegel RL, Miller KD, Jemal A (2019) Cancer statistics, 2019. CA Cancer J Clin 69:7–34. https://doi.org/10.3322/caac.21551CrossRefPubMed

Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA (2009) Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol 27:2758–2765. https://doi.org/10.1200/jco.2008.20.8983CrossRefPubMed

Takeda A et al (2013) Stereotactic ablative body radiation therapy for octogenarians with non-small cell lung cancer. Int J Radiat Oncol Biol Phys 86:257–263. https://doi.org/10.1016/j.ijrobp.2013.01.006CrossRefPubMed

Taremi M et al (2012) Stereotactic body radiotherapy for medically inoperable lung cancer: prospective, single-center study of 108 consecutive patients. Int J Radiat Oncol Biol Phys 82:967–973. https://doi.org/10.1016/j.ijrobp.2010.12.039CrossRefPubMed

Timmerman RD et al (2018) Stereotactic body radiation therapy for operable early-stage lung cancer: findings from the NRG oncology RTOG 0618 trial. JAMA Oncol 4:1263–1266. https://doi.org/10.1001/jamaoncol.2018.1251CrossRefPubMedPubMedCentral

Timmerman R et al (2010) Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA 303:1070–1076. https://doi.org/10.1001/jama.2010.261CrossRefPubMedPubMedCentral

Travis WD et al (2015) The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol 10:1243–1260. https://doi.org/10.1097/jto.0000000000000630CrossRefPubMed

Verstegen NE et al (2013) Stage I-II non-small-cell lung cancer treated using either stereotactic ablative radiotherapy (SABR) or lobectomy by video-assisted thoracoscopic surgery (VATS): outcomes of a propensity score-matched analysis. Ann Oncol 24:1543–1548. https://doi.org/10.1093/annonc/mdt026CrossRefPubMed

Videtic GMM et al (2017) Stereotactic body radiation therapy for early-stage non-small cell lung cancer: executive summary of an ASTRO evidence-based guideline. Pract Radiat Oncol 7:295–301. https://doi.org/10.1016/j.prro.2017.04.014CrossRefPubMed

Wu G, Gu X, Yuan D, Yao Y, Yang W, Lv T, Song Y (2019) Diagnosis status and pathological diagnosis derived treatment of elderly lung cancer patients over 75 years old. Transl Cancer Res 8:87–95. 10.21037/tcr.2018.12.35.

Title: Stereotactic body radiotherapy for elderly patients (≥ 75 years) with early-stage non-small cell lung cancer
Authors: Zekai Shu
Baiqiang Dong
Lei Shi
Wei Shen
Qingqing Hang
Jin Wang
Yuanyuan Chen
Publication date: 01-05-2020
Publisher: Springer Berlin Heidelberg
Keywords: NSCLC
Care
NSCLC
Radiotherapy
Published in: Journal of Cancer Research and Clinical Oncology / Issue 5/2020
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-020-03154-5

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Stereotactic body radiotherapy for elderly patients (≥ 75 years) with early-stage non-small cell lung cancer

Abstract

Purpose

Methods

Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2020

Treatment strategies for recurrent ovarian cancer in older adult patients in Japan: a study based on real-world data

The survival impact of postoperative complications after curative resection in patients with esophageal squamous cell carcinoma: propensity score-matching analysis

Cetuximab versus bevacizumab in metastatic colorectal cancer: a comparative effectiveness study

Microwave ablation for non-small cell lung cancer with synchronous solitary extracranial metastasis

Significance of unphosphorylated and phosphorylated heat shock protein 27 as a prognostic biomarker in pancreatic ductal adenocarcinoma

Radiomic profiles in diffuse glioma reveal distinct subtypes with prognostic value

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page