Elderly patients undergoing SBRT for inoperable early-stage NSCLC achieve similar outcomes to younger patients

• SBRT for NSCLC in the elderly achieves similar OS and LC as younger patients.
• Our study demonstrated increased distant failures in younger patients.
• Toxicity between cohorts is favorable with low grade ≥3 acute and/or late events.
• SBRT for early-stage NSCLC is safe and efficacious for elderly patients.

ObjectivesIt is unclear whether elderly patients face an increased risk of complications following stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer (NSCLC), as has been reported following surgical resection. This study evaluates toxicity and outcomes achieved with SBRT in elderly versus non-elderly patients.Materials and methodsWe retrospectively identified patients treated with SBRT for cT1-3N0M0 NSCLC between 2007 and 2013. We defined elderly and non-elderly cohorts by age ≥75 and <75. We used chi-square and logistic regression analyses to compare toxicity, and employed Kaplan-Meier, log-rank, and multivariable Cox proportional hazard analyses to assess overall survival (OS), local control (LC), and distant control (DC).ResultsWe identified 251 patients (126 elderly, 125 non-elderly) with a median follow-up of 3.0 years. No differences in acute or late grade ≥3 toxicity were observed. Acute grade ≥3 toxicity was 11.1% in elderly vs. 8.0% in non-elderly (p = 0.66). Late grade ≥3 toxicity was 10.3% in elderly vs. 7.2% in non-elderly (p = 0.50). There was one grade 5 toxicity (hemoptysis). There were no 3-year OS or LC differences between elderly and non-elderly patients (OS 47.5% vs. 41.0%, p = 0.75; LC 84.2% vs. 86.4%, p = 0.89). However, 3-year DC was superior in elderly patients (89.1% vs. 76.0%, p = 0.01). Improved DC remained associated with elderly age in Cox regression (HR 0.42, p = 0.01).ConclusionElderly patients undergoing SBRT for early stage NSCLC appear to have similar risk of toxicity and rate of efficacy as in younger patients. These findings support the use of SBRT in appropriately selected elderly patients.