Radiation Oncology Center, Ofuna Chuo Hospital, Kanagawa, Japan.
Int J Radiat Oncol Biol Phys. 2013 Jun 1;86(2):257-63. doi: 10.1016/j.ijrobp.2013.01.006. Epub 2013 Apr 6.
To retrospectively investigate treatment outcomes of stereotactic ablative body radiation therapy (SABR) for octogenarians with non-small cell lung cancer (NSCLC).
Between 2005 and 2012, 109 patients aged ≥80 years with T1-2N0M0 NSCLC were treated with SABR: 47 patients had histology-unproven lung cancer; 62 patients had pathologically proven NSCLC. The prescribed doses were either 50 Gy/5 fractions for peripheral tumors or 40 Gy/5 fractions for centrally located tumors. The treatment outcomes, toxicities, and the correlating factors for overall survival (OS) were evaluated.
The median follow-up duration after SABR was 24.2 (range, 3.0-64.6) months. Only limited toxicities were observed, except for 1 grade 5 radiation pneumonitis. The 3-year local, regional, and distant metastasis-free survival rates were 82.3%, 90.1%, and 76.8%, respectively. The OS and lung cancer-specific survival rates were 53.7% and 70.8%, respectively. Multivariate analysis revealed that medically inoperable, low body mass index, high T stage, and high C-reactive protein were the predictors for short OS. The OS for the operable octogenarians was significantly better than that for inoperable (P<.01).
Stereotactic ablative body radiation therapy for octogenarians was feasible, with excellent OS. Multivariate analysis revealed that operability was one of the predictors for OS. For medically operable octogenarians with early-stage NSCLC, SABR should be prospectively compared with resection.
回顾性调查立体定向消融体放射治疗（SABR）治疗非小细胞肺癌（NSCLC） 80 岁以上患者的治疗效果。
2005 年至 2012 年，109 例年龄≥80 岁的 T1-2N0M0 NSCLC 患者接受 SABR 治疗：47 例患者的肺癌未经组织学证实；62 例患者经病理证实为 NSCLC。外周肿瘤采用 50 Gy/5 个剂量，中央肿瘤采用 40 Gy/5 个剂量。评估治疗效果、毒性反应以及与总生存期（OS）相关的因素。
SABR 后中位随访时间为 24.2 个月（范围：3.0-64.6）。除 1 例 5 级放射性肺炎外，仅观察到有限的毒性反应。3 年局部、区域和远处无转移生存率分别为 82.3%、90.1%和 76.8%。OS 和肺癌特异性生存率分别为 53.7%和 70.8%。多变量分析显示，不能手术、低体重指数、高 T 分期和高 C 反应蛋白是 OS 短的预测因素。可手术的 80 岁以上患者的 OS 明显优于不可手术的患者（P<.01）。
SABR 治疗 80 岁以上患者是可行的，OS 良好。多变量分析显示，可操作性是 OS 的预测因素之一。对于身体状况可手术的早期 NSCLC 80 岁以上患者，应前瞻性地比较 SABR 与切除术。
