Eric D Brooks1, Bing Sun1, Lina Zhao1, Ritsuko Komaki1, Zhonxing Liao1, Melenda Jeter1, James W Welsh1, Michael S O'Reilly1, Daniel R Gomez1, Stephen M Hahn1, John V Heymach2, David C Rice3, Joe Y Chang4. 1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 2. Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 3. Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas. 4. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: jychang@mdanderson.org.
Abstract
PURPOSE: To discern the effectiveness and toxicity of stereotactic ablative radiation therapy (SABR) in the elderly population (aged ≥75 years) and to consider how SABR outcomes compare with surgical outcomes historically reported in the elderly. METHODS AND MATERIALS: A total of 772 patients with clinical early-stage I-II non-small cell lung cancer (NSCLC; stage T1-T3N0M0) underwent SABR (50 Gy in 4 fractions or 70 Gy in 10 fractions) from 2004 to 2014 at our center (n=442, aged <75 years; n=330, aged ≥75 years). The primary endpoints included overall survival (OS), time-to-progression, and grade ≥3 toxicity. The median follow-up time was approximately 55 months. RESULTS: Compared with patients aged <75 years, those aged ≥75 years had no difference in the time-to-progression (P=.419), lung cancer-specific survival (P=.275), or toxicity (P=.536). OS was the same between both age groups at 2 years of follow-up but diverged thereafter, with patients aged <75 years when treatment began having greater OS rates at 5 years. The median OS rates for patients aged ≥75 years were 86% at 1 year, 57.5% at 3 years, and 39.5% at 5 years. The median OS rates for patients aged <75 years were 87.3% at 1 year, 67.6% at 3 years, and 51.5% at 5 years. No patient aged ≥75 years experienced any grade 4 or 5 toxicity. CONCLUSIONS: The effectiveness of SABR was the same for the elderly as for the average-age population according to lung cancer-specific survival and time-to-progression. It also poses no increased toxicity. Compared with the historical outcomes with surgery in the elderly, SABR outcomes can be considered comparable for stage I-II disease but with less morbidity.
PURPOSE: To discern the effectiveness and toxicity of stereotactic ablative radiation therapy (SABR) in the elderly population (aged ≥75 years) and to consider how SABR outcomes compare with surgical outcomes historically reported in the elderly. METHODS AND MATERIALS: A total of 772 patients with clinical early-stage I-II non-small cell lung cancer (NSCLC; stage T1-T3N0M0) underwent SABR (50 Gy in 4 fractions or 70 Gy in 10 fractions) from 2004 to 2014 at our center (n=442, aged <75 years; n=330, aged ≥75 years). The primary endpoints included overall survival (OS), time-to-progression, and grade ≥3 toxicity. The median follow-up time was approximately 55 months. RESULTS: Compared with patients aged <75 years, those aged ≥75 years had no difference in the time-to-progression (P=.419), lung cancer-specific survival (P=.275), or toxicity (P=.536). OS was the same between both age groups at 2 years of follow-up but diverged thereafter, with patients aged <75 years when treatment began having greater OS rates at 5 years. The median OS rates for patients aged ≥75 years were 86% at 1 year, 57.5% at 3 years, and 39.5% at 5 years. The median OS rates for patients aged <75 years were 87.3% at 1 year, 67.6% at 3 years, and 51.5% at 5 years. No patient aged ≥75 years experienced any grade 4 or 5 toxicity. CONCLUSIONS: The effectiveness of SABR was the same for the elderly as for the average-age population according to lung cancer-specific survival and time-to-progression. It also poses no increased toxicity. Compared with the historical outcomes with surgery in the elderly, SABR outcomes can be considered comparable for stage I-II disease but with less morbidity.
Authors: Robert Timmerman; Rebecca Paulus; James Galvin; Jeffrey Michalski; William Straube; Jeffrey Bradley; Achilles Fakiris; Andrea Bezjak; Gregory Videtic; David Johnstone; Jack Fowler; Elizabeth Gore; Hak Choy Journal: JAMA Date: 2010-03-17 Impact factor: 56.272
Authors: Mojgan Taremi; Andrew Hope; Max Dahele; Shannon Pearson; Sharon Fung; Thomas Purdie; Anthony Brade; John Cho; Alexander Sun; Jean-Pierre Bissonnette; Andrea Bezjak Journal: Int J Radiat Oncol Biol Phys Date: 2011-03-04 Impact factor: 7.038
Authors: Joe Y Chang; Suresh Senan; Marinus A Paul; Reza J Mehran; Alexander V Louie; Peter Balter; Harry J M Groen; Stephen E McRae; Joachim Widder; Lei Feng; Ben E E M van den Borne; Mark F Munsell; Coen Hurkmans; Donald A Berry; Erik van Werkhoven; John J Kresl; Anne-Marie Dingemans; Omar Dawood; Cornelis J A Haasbeek; Larry S Carpenter; Katrien De Jaeger; Ritsuko Komaki; Ben J Slotman; Egbert F Smit; Jack A Roth Journal: Lancet Oncol Date: 2015-05-13 Impact factor: 41.316
Authors: Shervin M Shirvani; Jing Jiang; Joe Y Chang; James Welsh; Anna Likhacheva; Thomas A Buchholz; Stephen G Swisher; Benjamin D Smith Journal: JAMA Surg Date: 2014-12 Impact factor: 14.766
Authors: Frank J Lagerwaard; Cornelis J A Haasbeek; Egbert F Smit; Ben J Slotman; S Senan Journal: Int J Radiat Oncol Biol Phys Date: 2007-12-31 Impact factor: 7.038
Authors: Inga S Grills; Victor S Mangona; Robert Welsh; Gary Chmielewski; Erika McInerney; Shannon Martin; Jennifer Wloch; Hong Ye; Larry L Kestin Journal: J Clin Oncol Date: 2010-01-11 Impact factor: 44.544
Authors: Taylor R Cushman; Daniel Gomez; Rachit Kumar; Anna Likacheva; Joe Y Chang; Alex P Cadena; Sebastien Paris; James W Welsh Journal: J Thorac Dis Date: 2018-02 Impact factor: 2.895
Authors: Xiaoli Zheng; Yanan Sun; Ke Ye; Chengcheng Fan; Xiaohui Wang; Yang Yang; Ruidi Jiao; Hong Ge Journal: Thorac Cancer Date: 2021-02-02 Impact factor: 3.500