Abstract
BACKGROUND:
Stereotactic
body radiation therapy (SBRT) has demonstrated high rates of local control with
low morbidity and has now emerged as the standard of care for medically
inoperable, early stage non-small cell lung cancer (NSCLC). However, the impact
of lung SBRT on survival in the elderly population is less clear given
competing comorbid conditions. An analysis of the National Cancer Data Base
(NCDB) was undertaken to determine whether definitive SBRT improves survival
relative to observation alone patients ages 70 years and older.
METHODS:
The NCDB, a
retrospective national database that captures approximately 70% of all patients
treated for cancer, was queried for patients aged 70 years or older with early
stage (T1-T3N0M0) NSCLC from 2003 to 2006. Overall survival was compared
between patients who received stereotactic body radiotherapy alone and those
who received no treatment. An extended Cox proportional hazards model was
applied to estimate the treatment effect of SBRT.
RESULTS:
In total,
3147 patients met the selection criteria for this analysis. SBRT was elivered
to 258 patients (8.2%), and 2889 patients (91.8%) received no treatment. There
was no significant difference in the distribution of Charlson/Deyo comorbidity
index scores between the 2 groups (P = .076). Multivariable analysis revealed
improved overall survival with SBRT compared with observation for the entire
cohort (hazard ratio, 0.64; P < .001).
CONCLUSIONS:
SBRT is
associated with improved survival in elderly patients with early stage NSCLC
who have concurrent comorbid conditions compared with observation alone. The
current data support the use of SBRT for the treatment of elderly patients with
early stage NSCLC who have limiting comorbid conditions.