Stereotactic Body Radiotherapy in Octo- and Nonagenarians for the Treatment of Early Stage Lung Cancer
Menée à partir de données portant sur 1 083 patients atteints d'un cancer primitif du poumon (âge médian : 75 ans ; durée médiane de suivi : 1,7 ans), cette étude multicentrique évalue, en fonction de catégories d'âge (inférieur à 70 ans ; 70-79 ans, supérieur ou égal à 80 ans), l'efficacité, du point de vue des taux de récidive et de survie, et la sécurité d'une radiothérapie stéréotaxique corporelle
Purpose : To determine the safety and efficacy of lung SBRT in Octo- and Nonagenarians and to compare their outcomes to those of younger patients. Methods : Patients with primary lung cancer treated with SBRT were identified from a multi-institutional (5) database of 1083 cases. Details of patient factors, treatment specifics, toxicity and clinical outcomes were extracted from the database. All events were calculated from the end of radiotherapy. Estimates of local recurrence (LR), regional recurrence (RR), and distant metastases (DM) were calculated using the competing risk method. Cause specific (CSS) and overall survival (OS) were calculated using the Kaplan-Meier method. Outcomes were compared for those aged <70, 70-79, ≥80. Univariable (UVA) and multivariable analyses (MVA) was performed to determine associations with CSS and OS in patients aged ≥80. Results : The median follow-up was 1.7 years (1-10y) and median age 75 (41-94). There were 305 patients age <70 (28%), 448 age 70-79 (41%) and 330 age ≥80 (30%). There was no difference in 2 year LR (4.2% vs 5.4% vs 3.7%, p=0.7), RR (10.4% vs. 7.8% vs 5.3%, p=0.1), DM (12.2% vs 7.7% vs 9.5%, p=0.2) or CSS (90.6% vs 90.3% vs. 90.4%, p=0.6). Those age ≥80 had significantly lower 2 year OS (73.6% vs 67.2% vs 63.3%, p<0.01). The grade 3+ pneumonitis rate was 1.3% vs 1.6% vs 1.5% (p=1.0) in patients ages <70,70-79, ≥80 respectively. The 90 day mortality rates for patients aged <70, 70-79, ≥80 were 1.3%, 2.5%, and 2.4% (P=0.01) respectively. In patients aged ≥80 OS was associated with T-Category (HR1.7; P<0.01). Conclusion : SBRT is a safe treatment modality in elderly patients (aged ≥80). Despite larger tumor volumes, the tumor control outcomes were comparable to the younger patients treated with SBRT. All patients with early stage lung cancer, regardless of age, should be considered for treatment o with SBRT.