Stereotactic radiation therapy produces the same survival outcomes for elderly patients diagnosed with early-stage lung cancer as surgery, according to research presented at the 2010 Chicago Multidisciplinary Symposium in Thoracic Oncology held December 9-11.
According to the study, patients who underwent stereotactic radiation therapy had a lower risk of dying within the first 30 days following treatment, even though this was a frailer group of patients compared to controls. The research was conducted by a team from Amsterdam's VU University Medical Center, the Comprehensive Cancer Center, and the Netherlands Cancer Institute.
The group conducted a matched-pair analysis of the overall survival outcomes of patients living in north Holland who received treatment after being diagnosed with stage I non-small cell lung cancer (NSCLC) between 2005 and 2007. A total of 191 patients were identified from a comprehensive population-based registry. From this group, a total of 122 patients could be matched, half of whom had surgery and half of whom had stereotactic body radiation therapy (SBRT) treatments.
The median age of the patients at the time of diagnosis was 79 years. Patients were matched by age, gender, year of treatment, and T-stage. Baseline co-morbidities were not available, but a large number of patients who received the stereotactic radiation therapy were medically inoperable, according to lead author and presenter David Palma, MD, a radiation oncologist who conducted the study while on a research fellowship at VU University Medical Center. Palma is now practicing at the London Regional Cancer Program in London, Ontario.
Patients were followed for a median of 43 months. Six patients died within the first 30 days following treatment; five of these patients had undergone surgery. Overall survival at one year was 75% for surgical patients and 87% for radiation therapy patients. Three years following treatment, 60% of the surgery group and 41% of the radiation therapy group were alive.
"Many would expect that the patients treated with radiation therapy would do worse than those undergoing surgery," Palma told attendees at the American Society for Radiation Oncology (ASTRO)-sponsored symposium.
"At the time that these patients underwent treatment, patients only received radiation if they were too unwell for surgery or if they refused surgery," he continued. "Because most of these radiation therapy 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 radiation therapy patients lived just as long as the healthier patients who had surgery for the first 12 months following treatment."
Up to one-fourth of Dutch patients older than 75 who are diagnosed with stage I and stage II NSCLC do not receive any oncologic therapy, Palma said. Stereotactic body radiation therapy is an attractive treatment option for surgically unfit and/or elderly patients, due to its ease of administration and favorable toxicity profile, he explained.
"Patients prefer this treatment because there is no hospitalization associated with it, it doesn't require an anesthetic, there is no risk of infection from a surgical procedure, and it only takes a few treatments," Palma told AuntMinnie.com in an e-mail.
"I think that the use of stereotactic body radiation therapy will increase," he added. "We've seen over the past five years already that elderly patients and their physicians are choosing radiation more often to treat stage I lung cancer, and fewer patients are choosing to go without treatment as well. This study shows us that the stereotactic treatment is effective even for patients who have many medical problems."
A comparison of the costs of each treatment was not in the scope of the study. However, Palma said that cost-effectiveness studies are currently being performed, though results are not yet available. "In most countries with socialized medicine, once radiation therapy equipment has been purchased, the cost of radiation treatment is relatively inexpensive," he concluded.
By Cynthia E. Keen
AuntMinnie.com staff writer
December 17, 2010
Related Reading
SBRT improves control in inoperable lung cancer patients, March 16, 2010
Stereotactic radiotherapy effective in early inoperable lung cancer, April 20, 2009
High-dose stereotactic radiation effective for small lung metastases, March 26, 2009
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