title: Hypofractionated stereotactic body radiation therapy for elderly patients with stage IIB-IV nonsmall cell lung cancer who are ineligible for or refuse other treatment modalities.
abstract: OBJECTIVE
  In elderly patients with stage IIB-IV nonsmall cell lung cancer who cannot tolerate chemotherapy, conventionally fractionated radiotherapy is the treatment of choice. We present our experience with hypofractionated stereotactic body radiation therapy (SBRT) in the treatment of this patient population.
  
  
  METHODS
  Thirty-three patients with a median age of 80 years treated with fractionated SBRT were retrospectively analyzed. Most patients were smokers and had preexisting lung disease and either refused treatment or were ineligible. A median prescribed dose of 40 Gy was delivered to the prescription isodose line over a median of five treatments. The majority of patients (70%) did not receive chemotherapy.
  
  
  RESULTS
  With a median follow-up of 9 months (range: 4-40 months), the actuarial median overall survival (OS) and progression-free survival were 12 months for both. One year actuarial survival outcomes were 75%, 58%, 44%, and 48% for local control, regional control, progression-free survival, and OS, respectively. Increased volume of disease was a statistically significant predictor of worse OS. Three patients developed a grade 1 cough that peaked 3 weeks after treatment and resolved within 1 month. One patient developed grade 1 tracheal mucositis and three patients developed grade 1 pneumonitis. Both resolved 6 weeks after treatment. Three patients died within the first month of treatment, but the cause of death did not appear to be related to the treatment.
  
  
  CONCLUSIONS
  Hypofractionated SBRT is a relatively safe and convenient treatment option for elderly patients with inoperable stage IIB-IV nonsmall cell lung cancer. However, given the small sample size and the heterogeneity of the patient population, larger studies are needed before adopting this treatment option into clinical practice.
authors.affiliation: Department of Radiation Oncology, University of Colorado, Denver, CO, USA.
authors.forename: Sana D
authors.initials: SD
authors.lastname: Karam
authors.affiliation: Department of Radiation Oncology.
authors.forename: Zachary D
authors.initials: ZD
authors.lastname: Horne
authors.affiliation: Department of Radiation Oncology.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Hong
authors.affiliation: Department of Radiation Oncology.
authors.forename: Don
authors.initials: D
authors.lastname: McRae
authors.affiliation: Department of Pulmonary/Critical Care Medicine, Virginia Hospital Center, Arlington, VA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Duhamel
authors.affiliation: Department of Radiation Oncology.
authors.forename: Nadim M
authors.initials: NM
authors.lastname: Nasr
keywords: CyberKnife; chemotherapy; nodal; stage IIB; stage IIIA; stage IV; stereotactic body radiation therapy