Never too old: A single-institution experience of stereotactic body radiation therapy for patients 90 years and older with early stage lung cancer.

Abstract

To report on the patient, tumor, and treatment characteristics of patients aged 90 years or older who were treated with lung stereotactic body radiation therapy (SBRT) for early stage lung cancer and the resulting clinical outcomes. We surveyed our institutional review board-approved prospective lung SBRT data registry for patients aged 90 years or older who were treated for early stage lung cancer to determine the rates of local failure, progression-free survival, and overall survival as well as treatment-related toxicity. For the 2004 to 2016 time period, 19 patients (of a total of 1268 lung SBRT cases) were identified. The median age at treatment was 91.6 years (range, 90-97 years). Most patients were female (52.6%) and former smokers (78.9%). The median tumor size was 2.1 cm (range, 1.5-5.4 cm). Tissue was obtained for diagnosis in 68.4% of patients, with the predominant histology being adenocarcinoma (42.2%). Six patients (31.6%) had central lesions. The median follow-up for all patients was 17.3 months. The median SBRT schedule was 50 Gy in 5 fractions over 5 consecutive days and was used in 9 cases (47.4%). The median pre-SBRT and 6-month post-SBRT pulmonary testing showed that the forced expiratory volume in one second, as the percent predicted, was 81.9 and 84.5 and the diffusing capacity of the lungs for carbon monoxide, as the percent predicted, was 66.5 and 67, respectively. No grade 3 or higher toxicities were observed. The 2-year rates of local failure, progression-free survival, and overall survival were 5.6%, 48.6%, and 47.8%, respectively. Lung SBRT appears to be safe and effective in nonagenarians with stage I lung cancer. The absence of high-grade toxicities and mortality warrants its consideration as the primary curative modality in this population.