Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
Radiother Oncol. 2011 Nov;101(2):240-4. doi: 10.1016/j.radonc.2011.06.029. Epub 2011 Jul 19.
Elderly patients with stage I NSCLC who undergo surgical resection are at high risk of treatment-related toxicity. Stereotactic body radiation therapy (SBRT) may provide an alternative treatment with a favorable toxicity profile.
A population-based registry in North-Holland was used to conduct a matched-pair analysis of overall survival (OS) after surgery versus SBRT for elderly patients (age ⩾75) who were diagnosed between 2005 and 2007. Patients were matched by age, stage, gender, and treatment year; co-morbidity data was not available. SBRT was delivered at two centers; 17 centers provided surgery.
A total of 120 patients could be matched (60 surgery, 60 SBRT). Median age was 79years, 67% were male, and 64% had T1 disease. Median follow-up was 43months. Thirty-day mortality was 8.3% after surgery and 1.7% after SBRT. OS at one- and three-years was 75% and 60% after surgery, and 87% and 42% after SBRT, respectively (log-rank p=0.22). Limiting the analysis to SBRT patients with pathological confirmation of disease and their matches revealed no significant difference between groups.
Similar OS outcomes are achieved with surgery or SBRT for stage I NSCLC in elderly patients. Comorbidity data and outcomes from centralized surgical programs are needed for more robust conclusions.
接受手术切除的 I 期非小细胞肺癌老年患者存在治疗相关毒性的高风险。立体定向体部放射治疗（SBRT）可能提供一种毒性特征良好的替代治疗方法。
利用北荷兰的一个基于人群的登记处，对 2005 年至 2007 年间诊断的年龄 ⩾75 岁的老年患者（年龄 ⩾75 岁）进行手术与 SBRT 后总生存期（OS）的配对分析。患者按年龄、分期、性别和治疗年份进行匹配；共病数据不可用。SBRT 在两个中心进行；17 个中心提供手术。
共匹配了 120 名患者（60 例手术，60 例 SBRT）。中位年龄为 79 岁，67%为男性，64%为 T1 期疾病。中位随访时间为 43 个月。手术后 30 天死亡率为 8.3%，SBRT 后为 1.7%。手术后 1 年和 3 年的 OS 分别为 75%和 60%，SBRT 后分别为 87%和 42%（对数秩检验 p=0.22）。将 SBRT 患者的病理证实疾病及其匹配分析限制在组内，发现两组之间无显著差异。
对于 I 期非小细胞肺癌老年患者，手术或 SBRT 可获得相似的 OS 结果。需要更多集中手术计划的共病数据和结果来得出更有力的结论。
