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 r adiation therapy with curative intent for elderly patients diagnosed to hav e Stage I non-small cell lung cancer (NSCLC). The study involved a retrospe ctive review of 347 patients with T1 and T2N0M0 tumours treated at the Quee nsland 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 wi th 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 g roup was divided into those patients aged < 70 years and those patients age d <greater than or equal to> 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 <greater than or equal to> 70 years). The same division in terms of recurrence free survival yielded 5-year survival rates of 18% f or the age < 70 years group and 30% for the age <greater than or equal to> 70 years group with the median survival being 17 months in both sub-groups. Both the difference in overall survival and recurrence free survival betwe en the two age groups approached, but did not reach, statistical significan ce 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 poo rer outcome. The 75-79-year group showed better survival than other age gro ups 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 o f 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 p rice of minimal toxicity. a nihilist approach to treatment in the elderly c an no longer be justified. (C) 2001 Elsevier Science Ireland Ltd. All right s reserved.