Department of Radiation Oncology, VU University Medical Center, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
Cancer. 2010 Jan 15;116(2):406-14. doi: 10.1002/cncr.24759.
The number of patients aged > or =75 years who present with a stage I nonsmall cell lung cancer (NSCLC) is increasing. Elderly patients often have significant comorbidity and may be unfit for surgery. Furthermore, surgery in the elderly is associated with increased mortality and morbidity. In this study, the authors evaluated the outcomes of stereotactic radiotherapy (SRT) in elderly patients.
Since 2003, 203 tumors in 193 patients aged > or =75 years were treated using SRT (118 T1 tumors, 85 T2 tumors). The median patient age was 79 years, 80% of patients were considered medically inoperable, and 20% of patients declined surgery. The median Charlson comorbidity score was 4, and severe chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease Class III or greater) was present in 25% of patients. Risk-adapted SRT schemes were used with the same total dose of 60 grays in 3 fractions (33%), 5 fractions (50%), or 8 fractions (17% of patients), depending on the patient's risk for toxicity.
SRT was well tolerated, and all but 1 patient completed treatment. Survival rates at 1 year and 3 years were 86% and 45%, respectively. Survival was correlated with performance score (P = .001) and pre-SRT lung function (P = .04). The actuarial local control rate at 3 years was 89%. Acute toxicity was uncommon, and late Radiation Therapy Oncology Group grade > or =3 toxicity was observed in <10% of patients.
SRT achieved high local control rates with minimal toxicity in patients aged > or =75 years despite their significant medical comorbidities. These results indicated that more active diagnostic and therapeutic approaches are justified in elderly patients and that SRT should be considered and discussed as a curative treatment alternative.
年龄≥75 岁的Ⅰ期非小细胞肺癌（NSCLC）患者数量正在增加。老年患者常患有严重的合并症，可能不适合手术。此外，老年人手术相关的死亡率和发病率更高。在这项研究中，作者评估了立体定向放疗（SRT）在老年患者中的疗效。
自 2003 年以来，193 名年龄≥75 岁的患者中有 203 个肿瘤接受了 SRT 治疗（118 个 T1 肿瘤，85 个 T2 肿瘤）。患者的中位年龄为 79 岁，80%的患者被认为不能手术，20%的患者拒绝手术。中位 Charlson 合并症评分为 4 分，25%的患者患有严重的慢性阻塞性肺疾病（全球慢性阻塞性肺疾病倡议 III 级或更高）。根据患者毒性的风险，采用风险适应的 SRT 方案，总剂量为 60 戈瑞，分为 3 个剂量（33%）、5 个剂量（50%）或 8 个剂量（17%的患者）。
SRT 耐受性良好，除 1 例患者外，所有患者均完成了治疗。1 年和 3 年的生存率分别为 86%和 45%。生存与表现评分（P=0.001）和 SRT 前肺功能（P=0.04）相关。3 年时的 actuarial 局部控制率为 89%。急性毒性少见，<10%的患者出现迟发性放射治疗肿瘤学组（ Radiation Therapy Oncology Group）3 级以上毒性。
尽管患者存在严重的合并症，但 SRT 仍能在年龄≥75 岁的患者中实现高局部控制率和最小的毒性。这些结果表明，在老年患者中应采用更积极的诊断和治疗方法，SRT 应被视为一种有治愈潜力的替代治疗方法并进行讨论。
