Comparison of clinical outcome of stage I non-small cell lung cancer treated surgically or with stereotactic radiotherapy: Results from propensity score analysis

Mokhles, Sahar; Verstegen, Naomi E.; Maat, A.P.W.M.; Birim, Özcan; Bogers, Ad J.J.C.; Mokhles, M. Mostafa; Lagerwaard, Frank J.; Senan, Suresh; Takkenberg, Johanna J.M.

doi:10.1016/j.lungcan.2015.01.005

Cited by 65 publications

(34 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Most comparative studies have generally found patients undergoing surgery to have longer overall survival (OS) compared to SBRT patients (3, 7, 10) particularly when the operation performed is a lobectomy. However, studies comparing local/regional recurrence and disease-free survival after surgery or SBRT have shown mixed results.…”

Section: Introductionmentioning

confidence: 99%

“…However, studies comparing local/regional recurrence and disease-free survival after surgery or SBRT have shown mixed results. (1, 3, 8, 9) A part of the problem comparing locoregional control is the lack of uniformity between treating specialties (surgeons and radiation oncologists) and individual studies in definitions of local and regional recurrence as well as the varying schedules of follow-up imaging studies employed after surgery or SBRT. Additionally, both treatment modalities have evolved with the widespread use of thoracoscopic techniques in surgery and the improvement of radiation doses and fractions in SBRT.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment Outcomes in Stage I Lung Cancer

Puri

Crabtree

Bell

et al. 2015

Journal of Thoracic Oncology

View full text Add to dashboard Cite

Introduction The relative roles of surgery and stereotactic body radiation therapy in stage I non-small cell lung cancer (NSCLC) are evolving particularly for marginally operable patients. Since there is limited prospective comparative data for these treatment modalities, we evaluated their relative use and outcomes at the population level using a national database. Methods Patient variables and treatment-related outcomes were abstracted for patients with clinical stage I NSCLC from the National Cancer Database. Patients receiving surgery were compared to those undergoing SBRT in exploratory unmatched and subsequent propensity matched analyses. Results Between 1998 and 2010, 117618 patients underwent surgery or SBRT for clinical stage I NSCLC. Of these, 111731 (95%) received surgery while 5887 (5%) underwent SBRT. Patients in the surgery group were younger, more likely to be males, and had higher Charlson comorbidity scores. SBRT patients were more likely to have T1 (vs.T2) tumors and receive treatment at academic centers. Thirty-day surgical mortality was 2596/109485 (2.4%). Median overall survival favored the surgery group in both unmatched (68.4 months vs. 33.3 months, p<.001) and matched analysis based on patient characteristics (62.3 months vs. 33.1months, p<.001). Disease specific survival was unavailable from the dataset. Conclusion In a propensity matched comparison, patients selected for surgery have improved survival compared with SBRT. In the absence of information on cause of death and with limited variables to characterize comorbidity, it is not possible to assess the relative contribution of patient selection or better cancer control towards the improved survival. Rigorous prospective studies are needed to optimize patient selection for SBRT in the high-risk surgical population.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment Outcomes in Stage I Lung Cancer

Puri

Crabtree

Bell

et al. 2015

Journal of Thoracic Oncology

View full text Add to dashboard Cite

show abstract

“…[20] A recent propensity-matched analysis between SBRT and surgical patients found a 5-year OS of 53% versus 80% respectively, but did not reach significance (p=0.089). [21]…”

Section: 0 Discussionmentioning

confidence: 99%

Interpreting survival data from clinical trials of surgery versus stereotactic body radiation therapy in operable Stage I non-small cell lung cancer patients

et al. 2017

View full text Add to dashboard Cite

Objectives To identify the variability of short- and long-term survival outcomes among closed Phase III randomized controlled trials with small sample sizes comparing SBRT (stereotactic body radiation therapy) and surgical resection in operable clinical Stage I non-small cell lung cancer (NSCLC) patients. Patients and Methods Clinical Stage I NSCLC patients who underwent surgery at our institution meeting the inclusion/exclusion criteria for STARS (Randomized Study to Compare CyberKnife to Surgical Resection in Stage I Non-small Cell Lung Cancer), ROSEL (Trial of Either Surgery or Stereotactic Radiotherapy for Early Stage (IA) Lung Cancer), or both were identified. Bootstrapping analysis provided 10,000 iterations to depict 30-day mortality and three-year overall survival (OS) in cohorts of 16 patients (to simulate the STARS surgical arm), 27 patients (to simulate the pooled surgical arms of STARS and ROSEL), and 515 (to simulate the goal accrual for the surgical arm of STARS). Results From 2000 to 2012, 749/873 (86%) of clinical Stage I NSCLC patients who underwent resection were eligible for STARS only, ROSEL only, or both studies. When patients eligible for STARS only were repeatedly sampled with a cohort size of 16, the 3-year OS rates ranged from 27–100%, and 30-day mortality varied from 0–25%. When patients eligible for ROSEL or for both STARS and ROSEL underwent bootstrapping with n=27, the 3-year OS ranged from 46–100%, while 30-day mortality varied from 0–15%. Finally, when patients eligible for STARS were repeatedly sampled in groups of 515, 3-year OS narrowed to 70–85%, with 30-day mortality varying from 0–4%. Conclusion Short- and long-term survival outcomes from trials with small sample sizes are extremely variable and unreliable for extrapolation.

show abstract

“…SABR has become an increasingly advocated treatment modality for stage I NSCLC [9][10][11][12]. Improved screening may lead to an increase in patients with this diagnosis [13].…”

Section: Discussionmentioning

confidence: 99%

Reirradiation of recurrent node-positive non-small cell lung cancer after previous stereotactic radiotherapy for stage I disease

et al. 2017

View full text Add to dashboard Cite

The institutional recommendations reflect the questions and uncertainties discussed in current stage III guidelines. All institutions agreed that previous SABR is not a contraindication for salvage chemoradiation. In the absence of high-quality prospective trials for recurrent NSCLC, all treatment options recommended in current guidelines for stage III disease can be considered in clinical scenarios such as this.

show abstract

Comparison of clinical outcome of stage I non-small cell lung cancer treated surgically or with stereotactic radiotherapy: Results from propensity score analysis

Cited by 65 publications

References 34 publications

Treatment Outcomes in Stage I Lung Cancer

Treatment Outcomes in Stage I Lung Cancer

Interpreting survival data from clinical trials of surgery versus stereotactic body radiation therapy in operable Stage I non-small cell lung cancer patients

Reirradiation of recurrent node-positive non-small cell lung cancer after previous stereotactic radiotherapy for stage I disease

Contact Info

Product

Resources

About