Changes in Treatment Patterns and Overall Survival in Patients With Early-Stage Non–Small Cell Lung Cancer in the United States After the Incorporation of Stereotactic Ablative Radiation Therapy

Abstract

There has been an increase in RT utilization and decrease in surgical utilization after the incorporation of SABR by radiation oncologists within the United States. In addition, there has been an improvement in OS for patients treated with definitive RT for early-stage NSCLC between 2004 and 2012 that may be associated with increased utilization of SABR.

Video-assisted thoracoscopic lobectomy is associated with greater recurrence-free survival than stereotactic body radiotherapy for clinical stage I lung cancer

“…18 The local control rates in our study support using SBRT for medically inoperable stage I lung cancer in veterans. Despite the rapid increase in the use of SBRT 33,34 and the growing evidence of its superiority over conventionally fractionated radiotherapy, [8][9][10] SBRT has not yet become the dominant treatment modality for this indication in the United States. A recently published article revealed surprisingly low national use of SBRT for treating stage I NSCLC: Only 19% of surveyed US radiation oncologists reported using SBRT for their most recently treated medically inoperable patient with a peripheral lung tumor less than 5 cm.…”

Impact of Race on Treatment and Survival among U.S. Veterans with Early-Stage Lung Cancer

“…The findings also suggest that race is not a primary determinant of survival after radical therapy. As the utilization of stereotactic body radiotherapy for early-stage NSCLC continues to increase, 5,39 both black and white patients may have equal access to this treatment as well.…”

“…[2][3][4] For the significant percentage of patients with early-stage NSCLC who are ineligible for an operation on account of comorbid conditions, radiation therapy is the treatment of choice. 5 Survival rates for patients receiving radiotherapy or no therapy are inferior to those of patients undergoing an operation, with 5-year overall survival rates of 10% to 30% for those receiving radiotherapy, [5][6][7] and only 6% for those receiving no therapy. 8 Recent studies indicate a persistence of racial disparities in survival for patients in whom NSCLC has been diagnosed.…”

Scientific Advances in Thoracic Oncology 2016

“…The impact of stereotactic body RT (SBRT) for peripheral earlystage NSCLC is reflected in a Surveillance, Epidemiology, and End Results analysis showing that RT utilization rates for stage IA NSCLC increased from 13% to 29% between 2004 and 2012, with significant improvements in OS in the RT cohort. 119 A systematic review reported only limited changes in health-related QOL after SBRT. 120 For patients with centrally located lung tumors, both a prospective trial 121 and a literature overview 122 suggested that the toxicity rates of SBRT were acceptable, but the HILUS trial reported significant rates of fatal hemoptysis.…”