Comparison of different treatments for early-stage non-small cell lung cancer in the elderly

This study compared three different treatment strategies for early-stage non-small cell lung cancer (NSCLC) in the elderly.

The occurrence of early-stage NSCLC in the elderly is expected to rise by 2030. This will be due to the general increase in an older population as well as the rise in lung-cancer screening for long-term smokers. So, providing effective and affordable care for older patients will be an urgent need.

Currently there are three treatments available for early-stage NSCLC in the elderly. These are lobectomy, sublobar resection and stereotactic ablative radiotherapy (SABR). Lobectomy is the surgical removal of an entire lobe of a lung (the lungs have five lobes, three in the right and two in the left lung).  Sublobar resection is removal of a part of a lobe or a piece of a lung that is cancerous. In SABR, the tumor receives a high-dose of radiation while the surrounding normal cells receive a low dose. However, no recent clinical-trials have compared these treatment strategies in older patients.

The authors aimed to compare the three options available for treating early-stage NSCLC in the elderly.

In all, data from 9,093 early-stage NSCLC patients from online medical data bases were compared. The average age of patients was 75 years. Of the total number of patients, 79.4% had lobectomy, 16.5% had sublobar resection and 4.2% had SABR between 2003 and 2009.

After 90 days following treatment, the percentage of deaths was 4% for lobectomy, 3.7% for sublobar resection and 1.3% for SABR. However, at three years following the treatment, the percentage of deaths was 25% for lobectomy, 35.3% for sublobar resection and 45.1% for SABR.

There was a 32% increased risk of worse overall survival and lung-cancer specific survival (who have not died from NSCLC) for sublobar resection compared to lobectomy. Patients having SABR had better overall survival in the first 6 months compared to lobectomy but the long-term survival for SABR was poor. 

The authors concluded that lobectomy provided better survival benefits compared to sublobar resection in older patients with early-stage NSCLC. SABR could be an option for patients with more a more advanced age. 

Information on patients’ respiratory functions and general well being could not be obtained from the online databases. Also, only a small number of patients (4.2%) received SABR, which was first introduced during this study. Therefore, modern day outcomes with this technique with changes in dosing and other measures could be different.