PV QA 4 - Poster Viewing Q&A 4
Purpose/Objective(s): Patient frailty is an important topic of interest, and a modified frailty index (mFI) has been applied in the surgical fields to show that frailty is associated with worse outcomes. However, there is limited literature discussing frailty in patients with lung cancer treated with stereotactic body radiation therapy (SBRT). This study aims to assess the relationship between frailty and overall survival (OS), tumor control, and toxicity in patients with early stage non-small cell lung cancer (NSCLC) treated with SBRT.
Materials/Methods: A retrospective review of patients with early stage NSCLC treated with SBRT at a single institution between February 2009 and September 2014 was performed. A mFI consisting of 8 variables (hypertension requiring medication, diabetes, ECOG performance status≥2, history of transient ischemic attack or cerebrovascular accident, history of congestive heart failure, history of peripheral vascular disease, history of chronic obstructive pulmonary disease (COPD), and history of coronary artery disease) was created. One point was assigned to each variable, and patients were categorized as non-frail (mFI≤2) or frail (mFI>2). OS, recurrence free survival (RFS), and local, regional, and distant control (LC, RC, DC) were compared between frail and non-frail patients using Kaplan-Meier analysis and log rank tests. Univariate and multivariate analyses were conducted. Comparison of toxicity levels between frail and non-frail groups was analyzed using test of proportions.
Results: 140 cases of early stage NSCLC were included, with 49 (35.0%) frail and 91 (65.0%) non-frail. Most patients had T1aN0 stage (55.0%), and the highest stage was T2bN0. All of the variables in the mFI were found to be significantly greater in frail than in non-frail patients except for COPD. OS was significantly lower in frail than non-frail patients (p=0.007) with 3-year OS of 59% vs. 82%. LC and DC were significantly lower in frail patients than non-frail (LC: p=0.017, 3-year LC of 85% vs 97%; DC: p=0.03, 3-year DC of 81% vs 93%), as was RFS (p=0.014, 3-year RFS of 53% vs. 75%). Frailty remained a significant predictor for shorter overall survival on multivariate analysis (HR=1.98, 95% CI [1.02-3.85], p=0.04). Toxicity did not significantly differ between the two groups.
Conclusion: Frailty is associated with reduced OS and worse tumor control in patients with early stage NSCLC treated with SBRT. Characterizing frailty using a mFI prior to treatment could potentially help predict treatment outcomes and guide decision making and patient counseling. Future studies should evaluate associations between frailty, inflammatory markers, and radiation response, and compare outcomes between surgical and SBRT treatment approaches for NSCLC patients stratified by frailty to explore the possibility of an expanded role for SBRT in non-frail patients.
The asset you are trying to access is locked. Please enter your access key to unlock.