A population-based study of the effectiveness of stereotactic ablative radiotherapy versus conventional fractionated radiotherapy for clinical stage I non-small cell lung cancer patients

Abstract

BackgroundStereotactic ablative radiotherapy (SABR) is a promising option for non-operated early-stage non-small cell lung cancer (NSCLC) compared to conventional fractionated radiotherapy (CFRT). However, results from conclusive randomized controlled trials are not yet available. The aim of our study was to explore the effectiveness of SABR vs. CFRT for non-operated early-stage NSCLC.Patients and methodsWe used a comprehensive population-based database to identify clinical stage I non-operated NSCLC patients in Taiwan diagnosed from 2007 to 2013 who were treated with either SABR or CFRT. We used inverse probability weighting and the propensity score as the primary form of analysis to address the nonrandomization of treatment. In the supplementary analyses, we constructed subgroups based on propensity score matching to compare survival between patients treated with SABR vs. CFRT.ResultsWe identified 238 patients in our primary analysis. A good balance of covariates was achieved using the propensity score weighting. Overall survival (OS) was not significantly different between those treated with SABR vs. CFRT (SABR vs. CFRT: probability weighting adjusted hazard ratio [HR] 0.586, 95% confidence interval 0.264–1.101, p = 0.102). However, SABR was significantly favored in supplementary analyses.ConclusionsIn this population-based propensity-score adjusted analysis, we found that OS was not significantly different between those treated with SABR vs. CFRT in the primary analysis, although significance was observed in the supplementary analyses. Our results should be interpreted with caution given the database (i.e., nonrandomized) approach used in our study. Overall, further studies are required to explore these issues.

Old age and EGFR mutation status in inoperable early‐stage non‐small cell lung cancer patients receiving stereotactic ablative radiotherapy: A single institute experience of 71 patients in Taiwan

“… 20 Another study using a population‐based database of Taiwan found that nonoperated NSCLC receiving SABR had 5‐year OS of only 31%. 21 The 5‐year OS of 58.3% noted in this study is between the previous two studies and may reveal the current situation of a medical center in Taiwan. The local recurrence rate of 7.5% at 5‐years in the current study is comparable to the 6.3% noted in the revised STARS trial.…”

A meta-analysis comparing stereotactic body radiotherapy vs conventional radiotherapy in inoperable stage I non-small cell lung cancer

“…Six articles compared all-grade AEs [ 9 , 11 , 13 , 20 , 22 , 23 ] (Supplementary Digital Content, Table 4). The 10 most commonly reported AEs in all grades were pneumonitis, dyspnea, cough, fibrosis, acute kidney disease, radiation pneumonitis, skin reactions, fatigue, and chest wall pain (Table 2 ).…”

“…Five articles referred to grade 3–5 AEs, [ 9 , 11 , 13 , 20 , 23 ] in which SBRT was associated with no obvious difference (RR: 0.68 [0.30-1.53], P = .35) when compared with CRT (heterogeneity: P = .08, I 2 = 52%, Fig. 2 D) (Supplementary Digital Content, Table 5).…”

“…intervention and comparison: SBRT versus CRT (including conventional radiotherapy, [ 15 , 16 , 19 , 21 , 26 ] conventional fractionated radiotherapy, [ 17 , 20 , 23 , 25 , 27 ] 3D conformal radiotherapy, [ 9 , 11 , 13 , 14 , 18 ] and accelerated hypofractionated radiotherapy [ 13 ] );…”

Safety of image-guided radiotherapy in definitive radiotherapy for localized prostate cancer: a population-based analysis

“…The date of diagnosis in the TCR was defined as the index date, and OS was calculated from the date of diagnosis to the date of death, or 31 December 2017 (the censoring date of the death registry). The related covariates were collected based on the literature, 5,8 as well as based on our experiences in clinical care 9 and TCR studies, [10][11][12] to adjust for potential nonrandomized treatment selection (see below).…”