Analysis of first recurrence and survival in patients with stage I non–small cell lung cancer treated with surgical resection or stereotactic radiation therapy

Abstract

Objectives Comparative studies of survival between stereotactic body radiation therapy (SBRT) and surgery have been limited by lack of comparisons of recurrence patterns between matched cohorts in non-small cell lung cancer (NSCLC). Methods All patients undergoing treatment with surgery or SBRT for clinical Stage I NSCLC between June 2004-December 2010 were reviewed. Age, tumor characteristics, comorbidity score, pulmonary function, overall (OS) and disease free survival (DFS) and recurrence data were collected and propensity matching performed.. Results The mean age for surgery (N=458) was 65.8 ± 10.5 vs. 74.4 ± 9.4 for SBRT (N=151) (p<0.0001). For the entire surgical cohort 3-year OS and DFS were 78% and 72%, respectively. For the entire SBRT cohort 3-year OS and DFS were 47% and 42%, respectively. The overall local recurrence rate for surgery was 2.6%. The overall local recurrence rate for SBRT was 10.7%. A propensity matched comparison based on age, tumor size, ACE comorbidity score, FEV1%, and tumor location resulted in 56 matched pairs. The 3-year overall survival was 52% vs. 68% for SBRT and surgery, respectively (p=0.05) while disease-free survival was 47% vs. 65% (p=0.01). At 3 years, local recurrence free survival was 90% vs. 92% for SBRT and surgery, respectively (p=0.07) Conclusions While surgical resection seems to result in better overall and disease free survival vs. SBRT, matching these disparate cohorts of patients remains challenging. Participation in clinical trials is essential to define the indications and relative efficacy of surgery and radiation therapy in a high-risk population with Stage I NSCLC.

Combined Aortic Resection and Stent Graft Insertion for Local Recurrence of Metastatic Lung Carcinoma Following Stereotactic Radiotherapy: A Case Report

“…However, the overall local recurrence rate is 10.2%, which is significantly higher than the 2.6% recurrence rate following surgery. 1) In addition, SRT's high-dose radiation causes lung injury that leads to advanced local inflammation.…”

“…However, SRT can cause complications including a higher rate of local tumor recurrence compared to surgery, 1,2) and advanced fibrosis in normal lung parenchyma and radiation-induced injury. 3,4) We report a case of metastatic lung carcinoma that firmly adhered to the descending aorta after SRT and was treated with combined aortic resection and stent graft insertion.…”

Czy stereotaktyczna radioterapia stanowi równorzędną alternatywę dla chirurgii w I stopniu niedrobnokomórkowego raka płuca? Głos na TAK

“…Należy przy tym zauważyć, że dane z rejestrów nowotworowych, reprezentujące ryzyko powikłań z perspektywy populacji, są na ogół gorsze od danych dla poszczególnych instytucji, zwłaszcza renomowanych klinik uniwersyteckich. W porównaniu z nimi 30-i 90-dniowa umieralność po procedurze SBRT nie przekracza 1% [12,13], co jest jej niewątpliwą zaletą.…”

“…Porównania te miały charakter analiz bez uwzględnienia czynników rokowniczych [14], porównań z uwzględnieniem czynników rokowniczych z zastosowaniem doboru przypadków i grupy kontrolnej [12,[15][16][17][18], analiz wg modelu Markova [19,20], jak również metaanalizy wyników leczenia wczesnego raka płuca z wykorzystaniem SBRT vs chirurgii [21]. Wprawdzie czas przeżycia chorych operowanych analizowanych w tej ostatniej pracy był dłuższy w porównaniu z czasem przeżycia chorych poddanych SBRT, jednak 1-letnie i 3-letnie ryzyko zgonu z powodu nowotworu było takie same w obu grupach, co świadczy o negatywnej selekcji do grupy chorych poddanych radioterapii, prowadzącej do wyższego ryzyka zgonu z przyczyn pozanowotworowych.…”

Surgery versus SABR for early stage non-small cell lung cancer: the moving target of equipoise

“…Indeed, both have significantly evolved over the last decade, which do question the current validity of the results in the present meta-analysis. Regarding SABR, dose regimens across studies ranged from 32-60 Gy in 2-12 fractions, with several studies including patients treated below the guideline-recommended biologically effective (BED) tumour dose of 100 Gy 10 (3,4,8,11). Of greater concern, some studies did not include radiation dose information (5,7,9).…”