# SBRT in the Very Elderly: A Viable Option for Pulmonary Oligometastases?

## TL;DR

SBRT is a safe and effective treatment for lung cancer in patients aged 80 or older, with high success rates and minimal side effects.

## Contribution

This study provides evidence that SBRT is a viable curative treatment for pulmonary oligometastases in very elderly patients.

## Key findings

- SBRT achieved 95.2% local control at one year with minimal toxicity in patients aged ≥80.
- Median overall survival was 46.6 months with 70.9% cancer-specific survival at three years.
- No grade ≥3 toxicities occurred, and grade 2 side effects were rare and manageable.

## Abstract

The population of individuals aged ≥ 80 years is rapidly increasing, leading to more cancer diagnoses in this group. Stereotactic body radiotherapy (SBRT) is an established treatment for pulmonary oligometastases, but data for the very elderly are limited. We retrospectively analysed 34 patients aged ≥ 80 years (median 83) with 46 histologically confirmed pulmonary oligometastases treated with SBRT (median BED10: 112.5 Gy). Median follow-up was 22.6 months. One-, two-, and three-year local control rates were 95.2%, 95.2%, and 90.2%. Median overall survival was 46.6 months; 3-year cancer-specific survival was 70.9%. No grade ≥ 3 toxicities occurred; grade 2 pneumonitis and dermatitis were rare (2.9% each) and manageable. No significant predictors for local control or survival were identified. SBRT is safe, effective, and well-tolerated in patients aged ≥ 80 years with pulmonary oligometastases, supporting its use as a curative-intent option in this growing demographic.

Background/Objectives: The global population of individuals aged ≥ 80 years is rapidly growing, leading to an increasing incidence of cancer diagnoses in this age group. While stereotactic body radiotherapy (SBRT) has proven effective in treating pulmonary oligometastases, patients over 80 remain underrepresented in clinical analyses. This study aimed to evaluate clinical outcomes and toxicity of SBRT for pulmonary oligometastases in octogenarians. Methods: This retrospective, single-centre analysis included 34 patients aged ≥ 80 years treated with SBRT for histologically confirmed pulmonary oligometastases between 2010 and 2024. Results: A total of 46 pulmonary metastases were treated with curative intent using fractionation schemes of 3 × 15 Gy, 6 × 8 Gy, or 10 × 6 Gy. Median biologically effective dose (BED10) was 112.5 Gy. Follow-up included regular CT imaging and toxicity assessment according to CTCAE. With a median follow-up of 22.6 months, 1-, 2-, and 3-year local control (LC) rates were 95.2%, 95.2%, and 90.2%, respectively. Median overall survival (OS) was 46.6 months, with 1-, 2-, and 3-year OS rates of 78.4%, 71.4%, and 59.5%. Progression-free survival (PFS) at 1, 2, and 3 years was 63.4%, 51.6%, and 47.3%, respectively. No grade ≥ 3 toxicities were observed. Grade 2 pneumonitis and dermatitis occurred in 2.9% each and were well managed. Asymptomatic rib fractures were detected in 5.9% of patients. No significant predictors for LC, PFS, or OS were identified in univariate analysis. Conclusions: SBRT for pulmonary oligometastases in patients ≥ 80 years is feasible, safe, and effective. High local control, favourable cancer-specific survival, and minimal toxicity support its use as a curative-intent treatment in this growing patient population. These findings contribute important site- and age-specific evidence and support the inclusion of very elderly patients in future prospective SBRT trials.