Stereotactic body radiotherapy using real-time tumor tracking in octogenarians with non-small cell lung cancer

van der Voort van Zyp, Noëlle C.; van der Holt, Bronno; van Klaveren, Robertus J.; Pattynama, Peter; Maat, Alexander; Nuyttens, Joost J.

doi:10.1016/j.lungcan.2009.12.008

« Previous Next »Lung Cancer
Volume 69, Issue 3 , Pages 296-301, September 2010

Stereotactic body radiotherapy using real-time tumor tracking in octogenarians with non-small cell lung cancer

Noëlle C. van der Voort van Zyp
- Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands
- Corresponding author. Tel.: +31 10 7041507; fax: +31 10 7041013.
Bronno van der Holt
- Department of Trials & Statistics, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
Robertus J. van Klaveren
- Department of Pulmonology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
Peter Pattynama
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
Alexander Maat
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
Joost J. Nuyttens
- Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands

Received 28 August 2009; received in revised form 9 December 2009; accepted 14 December 2009. published online 08 January 2010.

Abstract

As the incidence of stage I non-small cell lung cancer (NSCLC) increases among octogenarians and only selected patients are surgical candidates, an alternative treatment is necessary. This manuscript evaluates the overall survival, local tumor control rate, and treatment-related toxicity after stereotactic body radiotherapy (SBRT) in 38 octogenarians with stage I NSCLC. Treatment consisted of 45Gy (n=4) or 60Gy (n=25) in 3 fractions for patients with peripheral tumors. A risk adaptive schedule of 45–60Gy in 3–6 fractions was used for central (n=7) or large peripheral tumors (n=2).

An overall survival rate of 65% at 1 year and 44% at 2 years was achieved in octogenarians after SBRT. The local tumor control rate was excellent (100% at 2 years) and no grade 4 or 5 treatment-related toxicity occurred. Despite the high incidence of comorbidity in these octogenarians (Charlson score ≥5 in 16% of patients), an approach that merely provides supportive care cannot always be justified. SBRT offers octogenarians with stage I NSCLC a good treatment alternative.

Keywords: Stereotactic radiotherapy, Octogenarians, Non-small cell lung cancer, CyberKnife, Local tumor control, Overall survival, Toxicity