Evaluating Real-World Outcomes of SBRT in Older Patients with Unresected NSCLC

Stereotactic Body Radiotherapy (SBRT) achieved meaningful long-term survival in older patients with unresected non–small cell lung cancer (NSCLC) in a recent retrospective cohort study. In this Medicare-age cohort with unresected stage I–IIB disease, 5‑year overall survival was 42.3% and median overall survival was 48.9 months—supporting SBRT as a curative‑intent option for selected older patients who are not surgical candidates.

When evaluating SBRT candidacy, overall survival and pre‑treatment diagnostic confirmation are the most practical metrics. The cohort’s 5‑year OS was 42.3% and 5‑year event‑free survival was 23.8%. The reported diagnostic biopsy rate within 12 months before SBRT was 90.1%, with a median biopsy‑to‑SBRT interval of about 49 days—indicating that high rates of tissue confirmation accompanied the observed survival outcomes and strengthening confidence in treatment planning when biopsy is feasible.

Biopsy was performed in 90.1% of patients within 12 months before SBRT; the minority without biopsy typically had competing risks (notably significant comorbidity or lesion inaccessibility) that increased procedural risk. Imaging‑based diagnosis and empiric treatment thus occurred in a small subset. The high confirmatory biopsy rate improves staging accuracy and downstream decision‑making by balancing diagnostic certainty against procedural risk in older patients.

Advanced disease stage at diagnosis correlated with worse survival—5‑year OS fell from roughly 44.7% for stage IA to about 24.7% for stage IIB—and median OS declined across stages. Baseline age (mean ~77 years) and comorbidity burden (mean Charlson Comorbidity Index ~2.4) are additional prognostic factors. These benchmarks can inform multidisciplinary selection pathways and shared decision‑making for older patients considered for curative‑intent SBRT.

Key Takeaways:

• SBRT yields robust real‑world 5‑year overall survival (42.3%) for older patients with unresected stage I–IIB NSCLC, supporting its role as a curative‑intent option for selected patients.
• The high diagnostic biopsy rate (90.1%) reinforces the value of tissue confirmation before SBRT when clinically feasible.
• Advanced stage and other clinical predictors should guide selection and counseling—multidisciplinary pathways can incorporate these benchmarks into decision‑making.