Use of frailty to predict survival in elderly patients with early stage non-small-cell lung cancer treated with stereotactic body radiation therapy. Issue 2 (March 2018)

• Record Type: Journal Article
• Authors: Franco, Idalid; Chen, Yu-Hui; Chipidza, Fallon; Agrawal, Vishesh; Romano, John; Baldini, Elizabeth; Chen, Aileen; Colson, Yolonda; Hou, Ying; Kozono, David; Wee, Jon; Mak, Raymond
• Is Part Of: Journal of geriatric oncology. Volume 9:Issue 2(2018)
• Page Start: 130
• Page End: 137
• Publication Date: 2018-03
• Subjects: Elderly -- Frailty -- Non-small cell lung cancer -- Radiation -- SBRT; Geriatric oncology -- Periodicals; Neoplasms -- Periodicals; Aged -- Periodicals; Geriatric oncology; Electronic journals; Periodicals; 618.976994005
• DOI: 10.1016/j.jgo.2017.09.002
• Languages: English
• ISSNs: 1879-4068

Abstract

Abstract: Objectives: Frailty has been shown to increase morbidity and mortality independent of age, but studies are lacking in radiation oncology. This study evaluates a modified frailty index (mFI) in predicting overall survival (OS) and non-cancer death for Stage I/II [N0M0] Non-Small-Cell Lung Cancer (NSCLC) patients treated with Stereotactic Body Radiation Therapy (SBRT). Materials and Methods: Medical records for all patients with Stage I/II NSCLC treated at our institution with SBRT from 2009 to 2014 were reviewed. A validated mFI score, consisting of 11 variables was calculated, classifying patients as non-frail (0–1) or frail (≥ 2). Primary endpoint (OS) was analyzed using Kaplan-Meier method and log-rank. Secondary endpoint, non-cancer death, was analyzed using Fine-Gray's method, with death from lung cancer as a competing risk. Results: Patient cohort consisted of 38 (27.3%) non-frail and 101 (72.7%) frail [median total mFI score 3.0 (range 0–7)]. Median age and pack-year history was 74 and 46 years, respectively. Median follow-up among survivors was 38.5 months (range 4.0–74.1 months). Frailty was associated with a lower 3-year OS (37.3% vs. 74.7%; p = 0.003) and 3-year cumulative incidence of non-cancer death (36.7% vs. 12.5%; p = 0.02). Frailty remained significant in the multivariate model [OS HR for mFI ≥ 2: 2.25 (1.14–4.44); p = 0.02]. Conclusion: Frailty is associated with lower OS in older patients with early stage NSCLC treated with SBRT, yet frail patients survived a median 2.5 years, and were more likely to die of causes unrelated to the primary lung cancer, suggesting SBRT should be considered even in older patients deemed unfit for surgery.