The curative treatment by radiation therapy alone of Stage I non-small cell lung cancer in a geriatric population

This review was initiated to assess the outcome of treatment with radical radiation therapy with curative intent for elderly patients diagnosed to have Stage I non-small cell lung cancer (NSCLC). The study involved a retrospective review of 347 patients with T1 and T2N0M0 tumours treated at the Queensland Radium Institute (QRI) during the period 1985-1992. The main reasons for not proceeding to surgery included poor performance status, old age or refusal to submit to surgery. The median age for the group was 70 years with the range being 34-90 years. Patients in this group were all treated by a standard technique involving external beam radiation therapy to a dose of 50 Gray Minimum Tumour Dose in 20 fractions over 4 weeks. When the study group was divided into those patients aged < 70 years and those patients aged 70 years, the overall survival at 5 years was 22 and 34%, respectively (median survival 22 months for age < 70 years, and 26 months for age 70 years). The same division in terms of recurrence free survival yielded 5-year survival rates of 18% for the age < 70 years group and 30% for the age 70 years group with the median survival being 17 months in both sub-groups. Both the difference in overall survival and recurrence free survival between the two age groups approached, but did not reach, statistical significance at the P < 0.05 lever of significance. Further sub-division into 5-year age groups failed to confirm the hypothesis that older age groups had a poorer outcome. The 75-79-year group showed better survival than other age groups with the 5-year overall survival for this group being 53%, while the 5-year recurrence free survival was 45%. We conclude from this large series of Stage I NSCLC that radical radiation therapy with curative intent may be a viable alternative to surgery in those elderly patients who either refuse surgery or are judged to be unfit for operation. In view of the fact that comparable results can be achieved in elderly lung cancer patients at the price of minimal toxicity. a nihilist approach to treatment in the elderly can no longer be justified. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.