Polish Journal of Thoracic and Cardiovascular Surgery
eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
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1/2026
vol. 23
 
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abstract:
Original paper

Stereotactic ablative radiotherapy versus surgery in octogenarian patients with early-stage lung cancer: a retrospective cohort study

Ghaith Qsous
1
,
Aditya Roshan
2
,
Naveed Kuniyil
2
,
Vipin Zamvar
3
,
Renzo Pessotto
3
,
Malcolm Will
3

  1. Nottingham University Hospital – Thoracic Surgery, United Kingdom
  2. University of Edinburgh, United Kingdom
  3. Royal Infirmary of Edinburgh –- Cardiothoracic Surgery, United Kingdom
Kardiochirurgia i Torakochirurgia Polska 2026; 23 (1): 1-7
DOI: https://doi.org/10.5114/ms.2026.160604
Online publish date: 2026/04/04
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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.

keywords:

lung cancer, octogenarian, stereotactic ablative radiotherapy
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