Does chemotherapy and SBRT improve survival in older patients with early stage non-small cell lung cancer (NSCLC)?

This study investigated chemotherapy (CT) and stereotactic body radiotherapy (SBRT) in older patients with early-stage non-small cell lung cancer (NSCLC). They found that CT after SBRT improved survival in older patients with tumors greater than 4 cm.

Non-small cell lung cancer (NSCLC) is the most common form of lung cancer (LC). Treatment of NSCLC depends on the stage of the disease. The first-line treatment (FLT) is surgery and chemotherapy (CT). Sometimes surgery is not an option. Stereotactic body radiotherapy (SBRT) can be used in this case. SBRT uses several radiation beams to shrink tumors. 

CT is usually combined with surgery to treat stage 1 and 2 NSCLC. Current guidelines do not recommend CT in combination with SBRT. However, relapse rates after SBRT range between 15% and 50%. Some studies suggest that adding CT could improve outcomes. There is some evidence that this improves survival in patients under 70. It is unclear if CT and SBRT improve outcomes in older patients. 

This study included 7042 patients aged 70 or older. Patient data were extracted from a database. Patients had stage 1 or 2 NSCLC. All patients underwent SBRT. 1015 patients also received CT. 

Patients with stage 1 NSCLC had better survival with SBRT only (25.4  vs. 20.3 months). This means that there was a 21% greater chance of survival with SBRT only. Patients with stage 2 NSCLC had better survival with SBRT and CT ( 20.2 vs. 14.2 months).  SBRT only was associated with a 34% lower chance of survival in stage II disease.

Tumor size also had an effect. Patients with tumors less than 4cm had a better survival (24.1 months overall survival) when treated with SBRT only compared to SBRT and CT (20.3 months). Survival rates were better in tumors of 4 cm or larger 4cm treated with SBRT and CT (18.5 months vs 15.5 months).

The authors concluded that CT after SBRT improved survival in older patients with stage II NSCLC and with tumors of 4 cm or larger.

This study was based on data from medical records. Patients were not randomly assigned to treatment. This could bias the results.