Session Item

In clinical practice many elderly patients are unfit to chemotherapy (ChT) due to age and/or comorbidities and are candidates to palliative radiotherapy (RT). There is a lack of prospective trials regarding the best schedule treatment in this setting of patients. We enrolled in a phase II trial unresectable locally advanced non-small cell lung cancer (LA-NSCLC) elderly patients to assess effectiveness and safety of exclusive stereotactic ablative radiotherapy (SABR).

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 and/or sequential 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). 

25 LA-NSCLC elderly patients unfit for concurrent and/or sequential ChT-RT were recruited. Median age was 81 years (range,72-89) and 15 (60%) were male. Histology was adenocarcinoma (ADK) and squamous cell carcinoma (SCC) in 17 (68%) and 8 (32%), respectively. The stage was IIB, IIIA and IIIB in 9(36%), 11(44%) and 5(20%) patients, respectively. All patients had ultra-central tumor with PTV overlapping the major airways. In 8 (32%) 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 18 months (range, 4-71) 6 (24%) and 7 (28%) patients had experienced isolated local recurrence and nodal regional recurrence at a median time of 9 (range, 7-17) and 9 months (range, 4-17), respectively. 5 (20%) patients developed distant metastases after a median time of 11 months (range, 4-26). At last follow-up, 19 (76%) patients were alive, 11 (44%) without radiological evidence of disease. Treatment compliance was 100% and no patients developed ≥ G3 acute and late toxicities. 

LA-NSCLC elderly patients treated with exclusive SABR had optimal local control and promising overall survival with excellent treatment compliance and absence of ≥G3 toxicity. Our preliminary prospective clinical outcomes provide an attraction to evaluate this approach in elderly patients unfit to ChT, to obtain a “big” cure beyond “little” palliation.