A Propensity-Matched Analysis of Survival of Clinically Diagnosed Early-Stage Lung Cancer and Biopsy-Proven Early-Stage Non-Small Cell Lung Cancer Following Stereotactic Ablative Radiotherapy

Abstract

PurposeStereotactic body radiotherapy (SBRT) has been increasingly regarded as a reasonable option for early-stage lung cancer patients without pretreatment pathologic results, but the efficacy and safety in a Chinese population remains unclear. The aim of this study was to compare survival outcomes and toxicities between patients with clinically diagnosed early-stage lung cancer or biopsy-proven early-stage non-small cell lung cancer and to demonstrate the rationality of this treatment.Material and MethodsFrom May 2012 to December 2018, 56 patients with clinically diagnosed early-stage lung cancer and 60 patients with early-stage biopsy-proven were selected into non-pathological group and pathological group, respectively. Propensity score matching (PSM) was performed to reduce patient selection bias. Survival analysis with log-rank test was used to assess the differences of treatment outcomes, which included local control (LC), progression-free survival (PFS), and overall survival (OS).ResultsThe median age was 76 (range 47–93) years, and the median follow-up time was 58.3 (range 4.3–95.1) months in the cohort without pathologic results. The median age was 74 (range 57–88) years, and the median follow-up time was 56.3 (range 2.6–94) months in the cohort with pathologic results. 45 matched-pair were analyzed. The 5-year LC, PFS, and OS rates in matched-pair patients with or without pathologic biopsy were 85.5% and 89.8%, 40.6% and 70.9%, and 63.2% and 76.1%, respectively. On Kaplan-Meier survival analysis after PSM analysis, there was no significant difference between patients with pathologic results versus patients with no pathologic results in terms of LC (P= 0.498) and OS (P=0.141). Of the matched-pair patients treated with SBRT, only 1 patient experienced grade 3 or above radiation pneumonitis.ConclusionFor early-stage lung cancer patients with medically inoperable or not suitable for invasive diagnosis, SBRT may be a good local treatment.

Dose–effect relationship of stereotactic body radiotherapy in non-small cell lung cancer patients

“…At present, there is no uniform standard for the prescription dose method of SBRT. Some prescription doses are defined as isocenter dose [ 23 , 24 , 34 ], and some are defined as isodose lines surrounding 95% PTV volume [ 32 , 35 , 36 ]. At the same time, the degrees of heterogeneity of dose in PTV for different centers may be diverse.…”

“…At the same time, the degrees of heterogeneity of dose in PTV for different centers may be diverse. The maximum dose in PTV at some centers is about 120% of the prescribed dose [ 35 ], while some is more than 160% [ 31 ]. Therefore, for the same nominal dose, it may occur that the actual dose given to PTV is not comparable [ 37 ].…”

Role of circular RNAs in the diagnosis, regulation of drug resistance and prognosis of lung cancer (Review)

“…Radiotherapy is clinically used as an adjunct therapy in the treatment of lung cancer. This therapy destroys the DNA of tumor cells leading to the death of cancer cells ( 75 ). The development of radioresistance, on the other hand, negates the benefits of radiotherapy ( 76 ).…”