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

Paul Kreinbrink, Philip Blumenfeld, George Tolekidis, Neilayan Sen, David Sher, Gaurav Marwaha

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective Stereotactic body radiotherapy (SBRT) for early-stage non-small-cell lung cancer (NSCLC) is the standard of care in medically inoperable patients. In very elderly patients, previous studies have shown SBRT to offer excellent local control, though with higher toxicities than in younger populations. We report our institutional experience using SBRT in the definitive management of NSCLC in patients ≥ 80 years old. Materials and Methods Using an IRB-approved registry of 158 patients treated with definitive-intent lung SBRT for early-stage NSCLC at our institution between 2010 and 2016, 31 consecutively treated patients ≥ 80 years of age were identified. CTCAEv4 scales were prospectively recorded during follow-ups and utilized for toxicity assessments. Kaplan–Meier estimates were utilized for survival analyses. Results For the 31 patients (with 34 lesions) included, median age was 83 (R: 80–93), median ECOG performance status was 2 (R: 0–3), and median follow-up was 15.8 months (R: 3.1–48.3). Median PTV size was 24.0 cm3 (R: 5.83–62.1 cm3). Median prescription dose was 54Gy in 3 fractions (R: 50-60Gy in 3–8 fractions). Local control was 100% at 1 year and 92.3% at 2 years. Median survival was 29.1 months. There were no grade 2–5 toxicities. Grade 1 toxicities included: fatigue in 5 patients (16.1%), asymptomatic (radiographic) pneumonitis in 12 (38.7%), and dyspnea in 2 (6.5%). Conclusions Lung SBRT with a BED of ≥ 100Gy10 for very elderly patients with NSCLC is extremely safe and effective, with inordinately low toxicity rates (zero grade 2–5 toxicities). With stringent dosimetric parameters and planning guidelines, patients ≥ 80 years remain excellent candidates for full-dose SBRT. Summary SBRT for early-stage NSCLC is the accepted standard of care in medically inoperable patients, though in many very elderly patients, dose is either de-intensified or withheld for concern of toxicity in the setting of advanced age and competing risks. In this study of our very elderly (≥ 80 years old) early-stage NSCLC patients, we highlight both the extremely high efficacy and tolerability (zero grade 2 or above toxicities) associated with definitive intent SBRT.

Original languageEnglish (US)
Pages (from-to)351-355
Number of pages5
JournalJournal of Geriatric Oncology
Volume8
Issue number5
DOIs
StatePublished - Sep 1 2017

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Non-Small Cell Lung Carcinoma
Radiotherapy
Lung
Standard of Care
Radiosurgery
Research Ethics Committees
Survival Analysis
Dyspnea
Fatigue
Prescriptions
Registries
Pneumonia
Guidelines
Survival

Keywords

  • Dosimetry
  • Elderly
  • Lung cancer
  • NSCLC
  • Radiation pneumonitis
  • Safety
  • SBRT
  • Toxicity

ASJC Scopus subject areas

  • Oncology
  • Geriatrics and Gerontology

Cite this

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. / Kreinbrink, Paul; Blumenfeld, Philip; Tolekidis, George; Sen, Neilayan; Sher, David; Marwaha, Gaurav.

In: Journal of Geriatric Oncology, Vol. 8, No. 5, 01.09.2017, p. 351-355.

Research output: Contribution to journalArticle

Kreinbrink, Paul ; Blumenfeld, Philip ; Tolekidis, George ; Sen, Neilayan ; Sher, David ; Marwaha, Gaurav. / 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. In: Journal of Geriatric Oncology. 2017 ; Vol. 8, No. 5. pp. 351-355.
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title = "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",
abstract = "Objective Stereotactic body radiotherapy (SBRT) for early-stage non-small-cell lung cancer (NSCLC) is the standard of care in medically inoperable patients. In very elderly patients, previous studies have shown SBRT to offer excellent local control, though with higher toxicities than in younger populations. We report our institutional experience using SBRT in the definitive management of NSCLC in patients ≥ 80 years old. Materials and Methods Using an IRB-approved registry of 158 patients treated with definitive-intent lung SBRT for early-stage NSCLC at our institution between 2010 and 2016, 31 consecutively treated patients ≥ 80 years of age were identified. CTCAEv4 scales were prospectively recorded during follow-ups and utilized for toxicity assessments. Kaplan–Meier estimates were utilized for survival analyses. Results For the 31 patients (with 34 lesions) included, median age was 83 (R: 80–93), median ECOG performance status was 2 (R: 0–3), and median follow-up was 15.8 months (R: 3.1–48.3). Median PTV size was 24.0 cm3 (R: 5.83–62.1 cm3). Median prescription dose was 54Gy in 3 fractions (R: 50-60Gy in 3–8 fractions). Local control was 100{\%} at 1 year and 92.3{\%} at 2 years. Median survival was 29.1 months. There were no grade 2–5 toxicities. Grade 1 toxicities included: fatigue in 5 patients (16.1{\%}), asymptomatic (radiographic) pneumonitis in 12 (38.7{\%}), and dyspnea in 2 (6.5{\%}). Conclusions Lung SBRT with a BED of ≥ 100Gy10 for very elderly patients with NSCLC is extremely safe and effective, with inordinately low toxicity rates (zero grade 2–5 toxicities). With stringent dosimetric parameters and planning guidelines, patients ≥ 80 years remain excellent candidates for full-dose SBRT. Summary SBRT for early-stage NSCLC is the accepted standard of care in medically inoperable patients, though in many very elderly patients, dose is either de-intensified or withheld for concern of toxicity in the setting of advanced age and competing risks. In this study of our very elderly (≥ 80 years old) early-stage NSCLC patients, we highlight both the extremely high efficacy and tolerability (zero grade 2 or above toxicities) associated with definitive intent SBRT.",
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AU - Blumenfeld, Philip

AU - Tolekidis, George

AU - Sen, Neilayan

AU - Sher, David

AU - Marwaha, Gaurav

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N2 - Objective Stereotactic body radiotherapy (SBRT) for early-stage non-small-cell lung cancer (NSCLC) is the standard of care in medically inoperable patients. In very elderly patients, previous studies have shown SBRT to offer excellent local control, though with higher toxicities than in younger populations. We report our institutional experience using SBRT in the definitive management of NSCLC in patients ≥ 80 years old. Materials and Methods Using an IRB-approved registry of 158 patients treated with definitive-intent lung SBRT for early-stage NSCLC at our institution between 2010 and 2016, 31 consecutively treated patients ≥ 80 years of age were identified. CTCAEv4 scales were prospectively recorded during follow-ups and utilized for toxicity assessments. Kaplan–Meier estimates were utilized for survival analyses. Results For the 31 patients (with 34 lesions) included, median age was 83 (R: 80–93), median ECOG performance status was 2 (R: 0–3), and median follow-up was 15.8 months (R: 3.1–48.3). Median PTV size was 24.0 cm3 (R: 5.83–62.1 cm3). Median prescription dose was 54Gy in 3 fractions (R: 50-60Gy in 3–8 fractions). Local control was 100% at 1 year and 92.3% at 2 years. Median survival was 29.1 months. There were no grade 2–5 toxicities. Grade 1 toxicities included: fatigue in 5 patients (16.1%), asymptomatic (radiographic) pneumonitis in 12 (38.7%), and dyspnea in 2 (6.5%). Conclusions Lung SBRT with a BED of ≥ 100Gy10 for very elderly patients with NSCLC is extremely safe and effective, with inordinately low toxicity rates (zero grade 2–5 toxicities). With stringent dosimetric parameters and planning guidelines, patients ≥ 80 years remain excellent candidates for full-dose SBRT. Summary SBRT for early-stage NSCLC is the accepted standard of care in medically inoperable patients, though in many very elderly patients, dose is either de-intensified or withheld for concern of toxicity in the setting of advanced age and competing risks. In this study of our very elderly (≥ 80 years old) early-stage NSCLC patients, we highlight both the extremely high efficacy and tolerability (zero grade 2 or above toxicities) associated with definitive intent SBRT.

AB - Objective Stereotactic body radiotherapy (SBRT) for early-stage non-small-cell lung cancer (NSCLC) is the standard of care in medically inoperable patients. In very elderly patients, previous studies have shown SBRT to offer excellent local control, though with higher toxicities than in younger populations. We report our institutional experience using SBRT in the definitive management of NSCLC in patients ≥ 80 years old. Materials and Methods Using an IRB-approved registry of 158 patients treated with definitive-intent lung SBRT for early-stage NSCLC at our institution between 2010 and 2016, 31 consecutively treated patients ≥ 80 years of age were identified. CTCAEv4 scales were prospectively recorded during follow-ups and utilized for toxicity assessments. Kaplan–Meier estimates were utilized for survival analyses. Results For the 31 patients (with 34 lesions) included, median age was 83 (R: 80–93), median ECOG performance status was 2 (R: 0–3), and median follow-up was 15.8 months (R: 3.1–48.3). Median PTV size was 24.0 cm3 (R: 5.83–62.1 cm3). Median prescription dose was 54Gy in 3 fractions (R: 50-60Gy in 3–8 fractions). Local control was 100% at 1 year and 92.3% at 2 years. Median survival was 29.1 months. There were no grade 2–5 toxicities. Grade 1 toxicities included: fatigue in 5 patients (16.1%), asymptomatic (radiographic) pneumonitis in 12 (38.7%), and dyspnea in 2 (6.5%). Conclusions Lung SBRT with a BED of ≥ 100Gy10 for very elderly patients with NSCLC is extremely safe and effective, with inordinately low toxicity rates (zero grade 2–5 toxicities). With stringent dosimetric parameters and planning guidelines, patients ≥ 80 years remain excellent candidates for full-dose SBRT. Summary SBRT for early-stage NSCLC is the accepted standard of care in medically inoperable patients, though in many very elderly patients, dose is either de-intensified or withheld for concern of toxicity in the setting of advanced age and competing risks. In this study of our very elderly (≥ 80 years old) early-stage NSCLC patients, we highlight both the extremely high efficacy and tolerability (zero grade 2 or above toxicities) associated with definitive intent SBRT.

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KW - Radiation pneumonitis

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