No Hyunsoo J, Lester-Coll Nataniel H, Seward David J, Sidiropoulos Nikoletta, Gagne Havaleh M, Nelson Carl J, Garrison Garth W, Kinsey C Matthew, Lin Steven H, Anker Christopher J
Radiation Oncology, Larner College of Medicine at the University of Vermont, Burlington, USA.
Radiation Oncology, University of Vermont Cancer Center, Burlington, USA.
Cureus. 2018 Oct 22;10(10):e3472. doi: 10.7759/cureus.3472.
Objectives Treatment for stage IA lung cancer may be too aggressive an approach in elderly patients with competing co-morbidities. We report outcomes for those electing active surveillance (AS) and investigate factors that may predict indolent disease. Materials and methods Retrospective review was performed for 12 consecutive patients, ≥70 years old, with medically inoperable stage IA, T1N0M0 lung cancer and significant co-morbidities, who chose AS with radiation therapy (RT) reserved for clear disease progression. Collected data included Charlson-Deyo Comorbidity Index (CDCI) grades, histology, and tumor size changes. Volume doubling time (VDT) calculations used a modified Schwartz equation. Results Fifteen nodules underwent AS in 12 patients; three patients had more than one nodule. Median age of all patients was 78 (range, 71-85). All patients' CDCI grades were ≥1, 7 were ≥2. Eleven of 12 patients were deemed to be at high-risk for falls. Twelve nodules in 12 patients were biopsied; adenocarcinoma the prevailing common (47%) histology. The median, one, two and three year patient freedom-from-RT values were 21.4 months (95% CI: 11.6-not reached), 81%, 43%, and 29%, respectively. Median VDT of treated vs. untreated nodules was 189 days (range, 62-infinite) vs. 1153 days (range, 504-infinite), respectively. No patient progressed regionally or distantly, and there have been no cancer-related deaths. Due to cardiovascular events, two patients died and one remains on hospice. Median duration of AS for those still continuing computed tomography (CT) surveillance is 35.1 months. Conclusion Selected elderly patients with stage IA lung cancer and significant co-morbidities may undergo AS without detriment in outcome. Prospective AS studies are warranted.
目的 对于合并多种并存疾病的老年IA期肺癌患者，治疗方法可能过于激进。我们报告了选择主动监测（AS）患者的结局，并研究了可能预测惰性疾病的因素。材料与方法 对连续12例年龄≥70岁、因医学原因无法手术的IA期、T1N0M0肺癌且并存疾病严重的患者进行回顾性研究，这些患者选择AS，仅在明确疾病进展时采用放射治疗（RT）。收集的数据包括Charlson-Deyo合并症指数（CDCI）分级、组织学类型和肿瘤大小变化。体积倍增时间（VDT）计算采用改良的施瓦茨方程。结果 12例患者中有15个结节接受了AS；3例患者有不止一个结节。所有患者的中位年龄为78岁（范围71 - 85岁）。所有患者的CDCI分级均≥1，7例≥2。12例患者中有11例被认为有跌倒高风险。12例患者中的12个结节接受了活检；腺癌是最常见的组织学类型（47%）。患者1年、2年和3年免于放疗的中位值分别为21.4个月（95%CI：11.6 - 未达到）、81%、43%和29%。接受治疗与未接受治疗结节的中位VDT分别为189天（范围62 - 无限）和1153天（范围504 - 无限）。没有患者出现局部或远处进展，也没有癌症相关死亡。由于心血管事件，2例患者死亡，1例仍在临终关怀中。仍在继续进行计算机断层扫描（CT）监测患者的AS中位持续时间为35.1个月。结论 部分合并严重并存疾病的老年IA期肺癌患者可进行AS，且不影响预后。有必要开展前瞻性AS研究。
