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Improvements in survival of elderly patients with stage I NSCLC in Netherlands between 2003-2009.

Improvements in survival of elderly patients with stage I NSCLC in Netherlands between 2003-2009. VU University medical center and C omprehensive Cancer Centre , The Netherlands. s .senan@vumc.nl. Elderly are fastest growing group of lung cancer patients

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Improvements in survival of elderly patients with stage I NSCLC in Netherlands between 2003-2009.

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  1. Improvements in survival of elderly patients with stage I NSCLC in Netherlands between 2003-2009. VU University medical center and Comprehensive Cancer Centre , The Netherlands. s.senan@vumc.nl • Elderly are fastest growing group of lung cancer patients • Nearly 40% of Dutch patients aged 75 years and older were untreated as they were unfit to undergo surgery (standard of care), and as conventional radiation had poor outcomes (takes 6-7 weeks, high recurrence rates) • Untreated early-stage lung cancer has a dismal survival.

  2. Stereotactic radiation therapy (SABR) is high precision outpatient therapy that achieves >90% local control rates. SABR was first introduced in The Netherlands in 2003 Background Key question addressed in our study: • Has survival improved in elderly patients with stage I NSCLC between 2001-2009 ? Why an epidemiological study? • Clinical trial not feasible in frail elderly patients but advantages of a population-based study are (i) it reflects real-world outcomes, (ii) less selection bias, (iii) best study design next to a randomized clinical trial

  3. Details of our study • Study of individual patient data collected by the Netherlands Cancer Registry from all resident Dutch cancer patients, in a total population of 16 million. • Of 930,000 Dutch residents aged 75 years or older, a total of 4605 patients developed a stage I lung cancer between 2001 and end-2009. • Data was split in three groups: • period A (2001-2003): pre-SABR • period B (2004-2006): SABR available in 2 centers • period C (2007-2009): full availability of SABR

  4. Key findings • Median survival of all patients rose by nearly 8 months between 2001 to 2009 (from 16.4 months in period A, to 24.4 months in period C). • Radiotherapy utilization increased from 31.2% to 37.7% (in period C); median survival of radiotherapy patients increased by 9.3 months (16.8 to 26.1 months,p<0.001) • Survival after surgery increased from 35.7 months in period A and it was not yet reached in period C (p<0.001). • No evidence for stage migration within stage I NSCLC

  5. Significance of our findings • Large survival improvements observed in patients aged ≥75 years due to both SABR and improved surgery • Further improvements expected with more SABR use (now approximately 70% in stage I NSCLC) • Elderly patients who are fit to undergo surgery, should also be informed about SABR as an alternative curative modality, particularly given the important differences in 30- and 90-day mortality between treatments.

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