Practice Patterns and Outcomes in Elderly Stage I Non–Small-cell Lung Cancer: A 2004 to 2012 SEER Analysis

We reviewed the population-based outcomes for elderly patients with stage I non–small-cell lung cancer (NSCLC) treated after the widespread adoption of stereotactic body radiation therapy (SBRT). Using the Surveillance, Epidemiology, and End Results database, biopsy-proven stage I NSCLC cases diagnosed from 2004 to 2012 were identified (n = 62,213). With advancing age, radiation replaced surgery as the most used local therapy for early-stage NSCLC. Concurrent with the widespread adoption of SBRT, overall and cancer-specific survival improved significantly for elderly stage I NSCLC patients treated with SBRT alone. Background: We reviewed the population-based treatment patterns and outcomes for elderly patients with stage I non–small-cell lung cancer (NSCLC) treated from 2004 to 2012. Patients and Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified biopsy-proven stage I NSCLC cases diagnosed from 2004 to 2012. The patients were divided into 5-year age subsets (60-64, 65-69, 70-74, 75-79, 80-84, 85-89, and ≥ 90 years). The demographic data, therapy, and survival were compared by year. Trends in overall survival (OS), cancer-specific survival (CSS), and practice patterns were analyzed. Results: A total of 62,213 cases were identified. The use of surgery declined sharply with age. Patients aged 60 to 64 years had a surgical rate of 81% compared with 21% for those aged ≥ 90 years (P <.0001). Radiation use increased (from 11% to 39%; P <.0001), as did the receipt of neither surgery nor radiation (from 7% to 40%; P <.0001). When analyzing the annual trends, radiation use increased, with fewer patients forgoing treatment from 2004 to 2012 (P <.0001). From 2004 to 2011, CSS at 2 years improved significantly for patients treated with radiation alone (from 48% to 72%; P <.0001) and more subtly for those receiving surgery alone (from 87% to 91%; P <.0001). The outcomes were stable for those receiving neither surgery nor radiation (38% to 45%; P = NS). Surgical outcomes declined with advancing age (P <.0001); however, the radiation outcomes did not (P = NS). Conclusion: With advancing age, radiation replaces surgery as the most used treatment for early-stage NSCLC. OS and CSS have improved significantly for elderly stage I NSCLC patients treated with radiation alone during a timeline concurrent with the widespread adoption of stereotactic body radiation therapy. Dedicated prospective studies are indicated, because these findings are limited by the inherent biases of using the SEER database alone.