Session Item

Although the standard of care in LA-NSCLC is concurrent chemo-radiotherapy (ChT-RT), there is a lack of prospective trials regarding the best treatment in elderly patients.

We enrolled in a phase II trial unresectable locally advanced non-small cell lung cancer (LA-NSCLC) elderly patients unfit to concurrent ChT-RT, to assess effectiveness and safety of stereotactic ablative radiotherapy (SABR) after neoadjuvant chemotherapy (ChT).

The cutoff of age ≥70 years was chosen as a commonly used definition of elderly in LA-NSCLC patients. All patients were unfit for concurrent chemo-radiotherapy (ChT-RT). The tumor volume included primary tumor (T) and CT-PET positive node/s (N). A simultaneous integrated boost (SIB) was optimized to differentiate the dose for primary tumor (T) and lymph-node/s (N). 

27 LA-NSCLC elderly patients unfit for concurrent ChT-RT were recruited. Median age was 73 years (range,70-85) and 21 (78%) were male. Histology was squamous cell carcinoma (SCC) and adenocarcinoma (ADK) and in 17 (63%) and 10 (37%), respectively. The stage was IIB, IIIA, IIIB and oligometastatic IV in 2 (7%), 9 (33%), 10 (37%) and 6 (22%) pts, respectively. All patients had ultra-central tumor with PTV overlapping the major airways. In 14 (52%) cases T and N were separately treated using SIB technique to administer a higher dose to T. Median prescribed dose was 40 Gy (range, 35-50) and 40 Gy (35-45) in 5 fractions to T and N, respectively. During a median follow-up of 19 months (range, 4-45), 7 (26%) and 11 (41%) patients had experienced local recurrence (LR) and nodal regional recurrence at a median time of 9 (range, 4-24) and 9 months (range, 4-28), respectively. 11 (41%) patients developed distant metastases after a median time of 9 months (range, 3-27).

At last follow-up, 21 (78%) patients were alive, 10 (48%) without radiological evidence of disease. Treatment compliance was 100% and no patients developed ≥ G3 acute and late toxicities. 

In our prospective trial, SABR after neoadjuvant ChT in LA-NSCLC elderly patients was safe and effectiveness. The treatment compliance was excellent and no patients experienced ≥G3 toxicity. Few fractions of SABR could represent an attractive option to obtain a great outcome in LA-NSCLC elderly patients unfit for concurrent ChT-RT.