Early-stage non-small cell lung cancer in the USA: patterns of care and survival among elderly patients at least 80 years old

Abstract

Background

The purpose of this study was to analyze the patterns of care of local therapies and their impact on overall survival (OS) among elderly patients with early-stage non-small cell lung cancer (NSCLC) in the USA.

Methods

The National Cancer Database was queried for patients at least age 80 years with NSCLC diagnosed in 2004–2013 with clinical stage T1–3N0M0. Local therapy was analyzed over time and by age. Multivariable (MVA) models were performed to investigate the impact of prognostic factors on OS.

Results

Among 40,561 patients meeting inclusion criteria, 17,418 (43%), 13,008 (32%), and 10,135 (25%) of patients underwent surgical resection, radiotherapy, and observation, respectively, as their initial mode of local therapy. Overtime, while the utilization of surgical managements generally remained stable, the utilization of conventionally fractionated radiotherapy and observation decreased in favor of stereotactic body radiotherapy (SBRT, p < 0.001). Among operable patients (n = 16,377), after MVA several factors were associated with OS including the choice of local therapy favoring resection over conventionally fractionated radiotherapy and observation (HR compared to lobectomy 1.362, and 2.656, respectively, each p < 0.001). In contrast, there was no statistical difference in OS between resection and SBRT among operable patients (HR for SBRT 1.128, p = 0.156).

Conclusions

The utilization of SBRT as the definitive local therapy in elderly patients with early-stage NSCLC is increasing in the USA. Given its generally favorable toxicity profile, SBRT should be considered in the substantial proportion of elderly patients still not receiving any definitive local therapy. Among medically operable elderly patients, OS was similar between resection and SBRT.

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