ESTRO 2024 - Abstract Book

S1797

Clinical - Lung

ESTRO 2024

Taking into account the increased risk of early mortality after surgery, the decision making process regarding elderly patients remains challenging because of the high level of comorbities 4-7 . Our objective is to assess and compare the overall survival and locoregional recurrence for elderly patients treated by surgery or SABR for localized NSCLC using a prospective surgical national data base.

Material/Methods:

We conducted a single-center retrospective study between January 2012 and December 2022 including patients over 75 years of age who received surgery or SABR for NSCLC less than 5cm in size, N0, M0 8 . Data for surgery cohort were collected from the EPITHOR® database of the French Society of Thoracic Surgery. Data for SABR cohort were collected from patient files. Patients' comorbidities were collected by an oncogeriatric assessment if the ONCODAGE score was < 14 9 . A cumulative comorbidity index was calculated for each patient, considering severity and impact on treatment. We performed subgroup analyses using the CART method to identify factors impacting survival and early death.

Results:

389 patients were included in the study, 288 of whom underwent surgery and 101 received SABR. After propensity score matching for age, gender, tumor size and comorbidity index, 127 operated patients were matched with 85 patients treated with SABR. In the matched population overall survival at 1 and 5 years in the was 83.87% and 47.30% versus 88.8% and 31.5% respectively in the surgery and SABR cohort p=0.068. Patient survival was better in SABR-treated patients in the first year, due to the strong impact of early surgery-related mortality. In the matched population, the number of deaths within 90 days of treatment was 8 in surgical patients (6.3%) and 1 in SABR treated patients (1.2%). In multivariate analysis, only WHO status was significantly associated with survival p=0.02 HR 1.47 (1.37-4.47). Subgroup analysis of overall survival highlighted the major impact of DLCO and comorbidity index (figure 1). We performed a decision making score to improve the selection of patients eligible for surgery, in a goal to reduce the early post-operative morality and finally improve the overall survival of elderly population treated for early NSLC (figure 2).