Carbon ion radiotherapy for elderly patients 80 years and older with stage I non-small cell lung cancer
Introduction
The World Health Organization has estimated that in 2004 there were 32.5 million people aged 60 years and older living in Japan, and that this number represented 25.6% of the population. At that time, the number of deaths per 100,000 people due to lung cancer was 71.3 for men and 24.8 for women, making lung cancer first among men and second among women as a cause of death [1], [2]. In the United States, about 80% of patients with lung cancer are over the age of 60, and about 22% are over the age of 80 [3].
In light of the explosion in the incidence of lung cancer in elderly people, there is a growing need for safe and effective treatments. Surgical resection has maintained a stubborn hold as the treatment for stage I non-small cell lung cancer (NSCLC) [4]. However, elderly patients who often suffer from other conditions, such as chronic obstructive pulmonary disease (COPD), cardiovascular disease, or other cancers, are not good candidates for surgery. In our hospital, we have used carbon ion radiotherapy (CIRT) for medically inoperable stage I NSCLC since 1994. Carbon ion beams have the physical advantage of delivering a highly precise dose concentration and having a high rate of biological effectiveness [5]. As we previously reported, through the prudent use of CIRT, we have been able to take full advantage of its unique and valuable characteristics for the treatment of stage I NSCLC. We have achieved high local control with low complication rates. In those clinical studies, all 129 patients with stage I NSCLC were able to complete CIRT. Median age of the patients was 75 years (range 47–88 years) and 106 patients were not eligible for surgery. The 5-year overall survival and local control rates for all patients were 43.4% and 91.7%, respectively. For patients with T2 disease, the 5-year local control rate was 84.7% [6], [7].
In this study, we evaluated the efficacy and toxicity of CIRT for stage I NSCLC, with a focus on elderly patients 80 years and older.
Section snippets
Patients and methods
Between April 1999 and November 2003, 129 patients with stage I NSCLC lung cancer were treated using CIRT at the National Institute of Radiological Sciences (NIRS) in Chiba, Japan. All patients were enrolled in a phase II study of CIRT for stage I NSCLC. Eligibility was based on histological evidence for the peripheral type of stage I NSCLC. All of the patients had a performance status (PS) score between 0 and 2 according to the World Health Organization guidelines, but the patient's age was
Survival and tumor control
The 2-year and 5-year local control rates were both 95.8% for the 29 lesions in the 28 elderly patients (Fig. 1). Only 1 patient with T2 disease who had a tumor that was 42 mm in size had local recurrence inside the radiation field 12 months after CIRT. In patients with T2 disease, the 2-year and 5-year local control rates were both 91.7%, and in patients with T1 disease they were 100% (Fig. 2). For tumors greater than 4 cm in size, the 5-year local control rate was 80.0%. In 10 patients without
Discussion
Surgical resection is the standard treatment for stage I NSCLC, with a 5-year overall survival rate of approximately 60–70% [18], [19], and a 5-year local control rate exceeding 80% [20]. When elderly patients with NSCLC who were able to be candidates for surgery were compared to younger patients, no differences in the 5-year overall survival rate by surgical resection were reported in some papers [4], [21], [22]. There were no significant differences reported in the rates of all complications,
Conclusions
In this study, the eligibility criteria were restricted to medically inoperable cases, and the general conditions of our cases were inferior to those for surgical cases. Considering these unfavorable conditions, carbon ion radiotherapy was successfully used and provided safe and effective results for elderly patients 80 years and older with stage I NSCLC. The use of CIRT is not widespread in the world but it has a significant potential for the control of lung cancer. For a thorough evaluation
Conflict of interest statement
None.
Acknowledgements
This work was supported by the Research Project with Heavy Ions at NIRS-HIMAC, JSPS KAKENHI (18591398) and a Grant-in-Aid for Cancer Research (19-06) from the Ministry of Health, Labour and Welfare. We are grateful to Ms. Hiroko Saitou (Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan), Dr. Tomoyasu Yashiro (Department of Thoracic Surgery, Nissan Tamagawa Hospital, Tokyo, Japan), Dr. Kenji Kagei (Department of Radiology, Kushiro
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