Co-morbidity index predicts for mortality after stereotactic body radiotherapy for medically inoperable early-stage non-small cell lung cancer

Purpuse: To determine the prognostic role of co-morbidity in medically inoperable early-stage non-small cell lung cancer (NSCLC) treated with stereotactic body radiotherapy (SBRT) Methods and materials: Between 2000 and 2007, 88 consecutive early-stage medically inoperable NSCLC patients were treated by linac-based SBRT. The dose was either 45 Gy or 67.5 Gy in three fractions prescribed to the isocenter. Baseline co-morbidities were retrospectively retrieved by consultation of a formal electronic registry of diagnoses as well as patients' charts. The age-adjusted Charlson Co-morbidity Index (CCI) was scored for each patient and subjected to univariate and multivariate analysis. Results. With a median follow-up of 44 months, the actuarial local control rate at 4 years was 89:;. while the median overall survival was 22 months. The median age-adjusted CCI score was 5 The age-adjusted CCI was a significant predictor of overall survival on both univariate (p = 0.1102) and multivariate analysis (p=0.011). Patients with an age-adjusted CCI score of 3 or less had a median survival of 41 months versus only 1 I months for those scoring 6 or more Conclusion The number and seriousness of co-morbidities predict overall survival in medically moperable early stage NSCLC treated with SBRT. Because the determination of medical operability is frequently based on both objective measures and subjective clinical judgment, it is recommended that co-morbidity be formally indexed in all studies examining the outcomes of SBRT. (C) 2009 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 93 (2009) 402-407