Introduction

With the adoption of lung cancer screening worldwide, there will be more patients presenting with early-stage lung cancer. Many of these patients are elderly (≥ 80 years old).

Aim

We aimed to determine the best treatment option for this group of patients.

Material and methods

Between 2013 and 2023, 160 patients aged ≥ 80 years with early-stage lung cancer (T1-2, N0) underwent either surgical resection (78 patients) or stereotactic ablative radiotherapy (SABR) (82 patients). Propensity-score matching with replacement was applied, in conjunction with analysis of the unmatched cohort, to assess differences related to age, performance status (PS), forced expiratory volume in the first second (FEV1), and Charlson Comorbidity Index (CCI).

Results

There was a significant difference in overall survival and 5-year survival of patients who underwent surgery compared to SABR (29% vs. 19.9%; p < 0.001; 52.5% vs. 23.1%; p = 0.001). The SABR group had a lower rate of recurrence compared to the surgery group, but this difference was not significant (12.2% vs. 15.3%; p = 0.558). The propensity score-matched cohort yielded 73 pairs, and suggested better survival at 5 years for patients who underwent surgery compared to SABR (54.5% vs. 18.5%; p < 0.001).

Conclusions

Surgery may provide a survival benefit when compared to SABR therapy for elderly patients in the longer term. SABR remains an important consideration for those who may not tolerate surgery, especially in the short term.