Video-assisted thoracic lobectomy versus stereotactic body radiotherapy for stage I nonsmall cell lung cancer in elderly patients: a propensity matched comparative analysis.

Comparative studies of the overall survival (OS) in elderly patients with nonsmall cell lung cancer (NSCLC) after surgery or stereotactic body radiotherapy (SBRT) have been limited by mixed extents of resection and different surgical approaches.792 patients aged ≥65 years with clinical stage I NSCLC underwent video-assisted thoracic surgery (VATS) lobectomy or SBRT between 2010 and 2015. The propensity score-matched primary analysis included data from the full cohort; the secondary analysis included data from a subgroup of patients with data on pulmonary function.Median OS for unmatched patients was 77 months for patients undergoing VATS lobectomy and 38 months for SBRT. The 1-, 3- and 5-year OS rates after VATS lobectomy were 92%, 76% and 65%, and after SBRT were 90%, 52% and 29% (p<0.001). Median OS for matched patients in the primary analysis was 77 months for patients undergoing VATS lobectomy and 33 months for SBRT. The 1-, 3- and 5-year OS rates after VATS lobectomy were 91%, 68% and 58%, and after SBRT were 87%, 46% and 29% (p<0.001). The survival advantage with VATS lobectomy persisted in the secondary analysis after adjusting for non-matched variables (p=0.034).We suggest that elderly patients with stage I NSCLC undergoing VATS lobectomy have a better rate of OS than patients undergoing SBRT, irrespective of matching. This could be clinically important in decision-making for elderly patients who can tolerate surgery.

Postoperative Outcome After Pulmonary Surgery for Non-Small Cell Lung Cancer in Elderly Patients.

BACKGROUND: Lung cancer is the main cause of cancer-related death in the Netherlands. Surgery offers the best potential cure, but lower rates of surgery are recorded for octogenarians because of concerns regarding morbidity and mortality. METHODS: We analyzed the Dutch Lung Surgery Audit database to determine the postoperative outcome of lung cancer resections for patients aged 60 years or more between January 2013 and December 2014. Three groups were compared: patients aged 80 years or more, patients aged 70 to 79 years, and patients aged 60 to 69 years. Multivariable analysis was done of postoperative complications and operative mortality. RESULTS: In all, 2,133 lung cancer resections were performed, of which 70.5% by video-assisted thoracic surgery. Postoperative complications were observed in 637 patients (29.9%), without any difference among the three age groups (p = 0.278). Factors associated with complications were sex, percentage predicted forced expiratory volume in 1 second, percentage predicted diffusion capacity of lung for carbon monoxide, coronary artery bypass graft, chronic obstructive pulmonary disease, and resection more extensive than limited. The mean operative mortality was 2.1% (44 patients), 6.0% (10 patients) among octogenarians (p < 0.001). Age 80 years or more, percentage predicted forced expiratory volume in 1 second, performance status, and congestive heart failure independently predicted operative mortality. CONCLUSIONS: A higher operative mortality rate was observed among octogenarians, but the incidence of complications was similar in all age groups.

Changes in treatment patterns and survival in elderly patients with stage I non-small-cell lung cancer with the introduction of stereotactic body radiotherapy and video-assisted thoracic surgery.

BACKGROUND: The optimal treatment of elderly patients with early-stage non-small-cell lung cancer (NSCLC) remains elusive. Still, the introduction of video-assisted thoracic surgery (VATS) and stereotactic body radiotherapy (SBRT) may have led to more elderly receiving treatment and improved median overall survival (OS). MATERIALS AND METHODS: We analysed data from the Netherlands Cancer Registry of 2168 patients ≥65 years with clinical stage I NSCLC and distinguished two periods: 2004-2008 (A) and 2009-2013 (B). The analyses focussed on treatment patterns and median OS for patients receiving surgery, radiotherapy or neither surgery nor radiotherapy. Furthermore, we explored the influence of the application of VATS and SBRT. RESULTS: The resection rate did not differ between the periods A and B (51% versus 53%; p = 0.37), despite significantly more VATS procedures in the latter period (0% versus 32%; p < 0.001). Application of radiotherapy increased (26% versus 33%; p = 0.001), especially SBRT (3% versus 63%; p < 0.001). The proportion of patients receiving neither therapy decreased (23% versus 14%; p < 0.001). Median OS for all patients significantly improved (31 versus 42 months; p = 0.001), and also for those receiving radiotherapy (23 versus 33 months; p = 0.02), but not significantly for surgical patients (65 versus 74 months; p = 0.16). Still, in multivariable analysis, surgical patients had an increased risk of death in period A compared with period B (hazard ratio [HR] 1.20; 95% confidence interval [CI], 1.01-1.43); this was not the case for patients receiving radiotherapy (HR 1.19; 95% CI, 0.99-1.43). Five-year OS was 57% for surgical patients and 23% for those receiving radiotherapy. CONCLUSION: In elderly patients with stage I NSCLC, the use of surgery remained constant, that of radiotherapy increased and fewer patients received neither treatment over the years. Median OS improved for all patients; surgery was associated with the highest long-term OS.