title: Stereotactic Body Radiotherapy for Early-stage Non-small-cell Lung Cancer in Patients 80 Years and Older: A Multi-center Analysis.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Department of Radiation Oncology, Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA. Electronic address: richardjcassidy@emory.edu.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Cassidy
authors.affiliation: Department of Radiation Oncology, Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA.
authors.forename: Pretesh R
authors.initials: PR
authors.lastname: Patel
authors.affiliation: Department of Biostatistics and Bioinformatics, Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA.
authors.forename: Xinyan
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Press
authors.affiliation: Department of Biostatistics and Bioinformatics, Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Switchenko
authors.affiliation: Department of Medical Oncology, Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA.
authors.forename: Rathi N
authors.initials: RN
authors.lastname: Pillai
authors.affiliation: Department of Medical Oncology, Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA.
authors.forename: Taofeek K
authors.initials: TK
authors.lastname: Owonikoko
authors.affiliation: Department of Medical Oncology, Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA.
authors.forename: Suresh S
authors.initials: SS
authors.lastname: Ramalingam
authors.affiliation: Department of Thoracic Surgery, Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA.
authors.forename: Felix G
authors.initials: FG
authors.lastname: Fernandez
authors.affiliation: Department of Thoracic Surgery, Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA.
authors.forename: Seth D
authors.initials: SD
authors.lastname: Force
authors.affiliation: Department of Radiation Oncology, Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Curran
authors.affiliation: Department of Radiation Oncology, Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Higgins
mesh_terms: D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy*; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008175:Lung Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D008297:Male; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D016634:Radiosurgery / Q000009:adverse effects; D015996:Survival Rate; D047368:Tumor Burden
keywords: Geriatric oncologic; Nonagenarians; Octogenarians; Performance status; Radiation pneumonitis