Surgery Versus Stereotactic Radiotherapy in Patients over 75 Years Treated for Stage IA-IIA NSCLC

INTRODUCTION

Lobectomy with lymph node dissection is the gold standard treatment for stage IA-IIA Non-Small Cell Lung Cancer (NSCLC). Surgery is responsible for higher early mortality but offers better overall long-term survival. The patient population concerned is often elderly and combines the comorbidities of smoking and age. Several trials have shown good results of stereotactic radiotherapy (SABR) in terms of local control and tolerance in elderly subjects. Our objective is to study the survival and regional control of patients over 75 years treated by surgery or SABR for localized NSCLC.

MATERIALS AND METHOD

We conducted a single-center retrospective study between January 2012 and December 2022 including elderly patients who received surgery or SABR for NSCLC less than 5 cm in size, N0, M0. A cumulative comorbidity index was calculated for each patient, considering severity and impact of treatment. We performed subgroup analyses using CART method to identify factors impacting survival and early death.

RESULTS

After propensity score matching, 127 operated patients were matched to 85 patients treated with SABR. Overall survival at 1 and 5 years for the operated patients was 83.87% and 47.30% compared with 88.8% and 31.5% in the radiotherapy group (p = 0.068). We have identified four factors influencing the incidence of early mortality: gender, World Health Organization Performance status (WHO status), Forced Expiratory Volume in 1 s (FEV1), and treatment group.

CONCLUSIONS

Surgery seems to remain the standard of treatment in terms of overall survival and locoregional recurrence, in a context where SABR nevertheless provides excellent local control and tolerance in the short and long term. In order to improve patient selection, we are proposing for the first time a tool to aid therapeutic decision-making.