ASTRO: Radiosurgery catches up to surgery in elderly

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Elderly patients with non-small cell lung cancer (NSCLC) treated with radiosurgery survived just as long as patients that underwent surgery, with radiosurgery yielding higher 30-day and one-year survival rates, according to a study being presented at the 2010 Chicago Multidisciplinary Symposium in Thoracic Oncology.

Surgery has been the standard treatment for early stage NSCLC; however, the researchers investigated whether stereotactic body radiation therapy (SBRT) yielded comparably effective survival rates in patients 75 years and older, in whom surgery is either more risky or medically implausible. "Treatment of stage I NSCLC in elderly patients is a therapeutic challenge, and can be hampered by patient frailty, co-morbidity, or concerns about toxicity," wrote David Palma, MD, of VU University Medical Center in Amsterdam, and colleagues.

Noting that "data comparing surgery and SBRT for elderly stage I NSCLC is lacking," Palma and colleagues compared the survival rates of 61 elderly stage I NSCLC patients treated with surgery with 81 stage I NSCLC patients treated with SBRT. The patients, median age 79 years, were followed for a median of 43 months. Most of the SBRT patients were medically inoperable.

The respective one month survival rates for surgery and radiosurgery were 92 percent (five deaths) and 98 percent (one death). Seventy-five percent of surgery patients survived for one year, compared with 87 percent of SBRT patients.

After three years, however, overall survival for surgery patients was 60 percent, compared with 40 percent for SBRT patients.The difference was not statistically significant, and researchers claimed that "there was no difference in OS [overall survival] between surgery or SBRT."

The authors highlighted the fact that "[b]ecause most radiotherapy patients had medical problems that prevented them from having surgery, we would expect them not to live as long as the surgery patients. Yet, despite this disadvantage, the radiotherapy patients lived just as long."

Palma and colleagues induced that this finding "shows us that the stereotactic treatment is effective even in patients who have many medical problems."