B. N. Arnold1, D. C. Thomas1, J. E. Rosen1, M. C. Salazar1, F. C. Detterbeck1, J. D. Blasberg1, D. J. Boffa1, A. W. Kim1 1Yale University School Of Medicine,Department Of Surgery, Section Of Thoracic Surgery,New Haven, CT, USA
Introduction: Nonagenarians are the fastest growing subset of the United States population, and non-small cell lung cancer (NSCLC) is the most common cancer in the elderly population. Stage I NSCLC is a potentially curable disease with 5-year survival approaching 50%, yet older patients undergo treatment at lower rates than younger patients. This analysis sought to describe the scope of treatment in nonagenarians with early stage NSCLC and to provide data on outcomes of these patients in order to better guide treatment decisions in this growing population of patients.
Methods: The National Cancer DataBase was queried for all patients age 90 years and older with stage I NSCLC (tumors ≤4 cm). Patients were divided into three treatment groups: local therapy (surgery, stereotactic body radiation (SBRT)), other therapy, or no treatment. The primary outcomes were 5-year overall and relative survival. Surgery and SBRT were compared in a subset analysis.
Results: Of the 616 patients identified, 202 (33%) were treated with local therapy, 207 (34%) were treated with other therapy, and 207 (34%) underwent no treatment. Of those treated with local therapy, there were 40 (20%) lobectomies, 35 (17%) sublobar resections, and 127 (63%) patients who underwent SBRT. Of those treated with other therapy, 188 (91%) received standard radiation therapy of varying doses, 13 (6%) received combination therapy, and 6 (3%) received chemotherapy. Five-year overall survival was significantly lower with no treatment (8%) and other therapy (13%) compared to local therapy (23%) (p<0.0001). This effect remained significant after adjusting for covariates in a Cox model (HR for other therapy 1.428, 95% CI 1.11-1.83, p=0.0053; HR for no treatment 2.50, 95% CI 1.95-3.21, p<0.0001). The 5-year relative survival differed by treatment, with 81% for local therapy, 49% for other therapy, and 32% for no treatment (p<0.0001). In the subset analysis, there was no difference in overall survival between surgery (26%) and SBRT (20%) (p=0.33).
Conclusion: Nonagenarians who are managed with local therapy for stage I NSCLC (tumors ≤4 cm) have better overall survival than those who receive other therapy or no treatment, regardless of the type of local therapy. Nonagenarians with stage I lung cancer derive a benefit from treatment and should be treated with either surgery or SBRT if able to tolerate treatment.
