Role of stereotactic body radiotherapy for early‐stage non‐small‐cell lung cancer in patients borderline for surgery due to impaired pulmonary function

Abstract

Aim Stereotactic body radiotherapy (SBRT) is recommended only for inoperable patients with early‐stage (e‐stage) non‐small‐cell lung cancer (NSCLC). We compared outcomes between surgery and SBRT in patients borderline for surgery due to impaired pulmonary function (PF). Methods We reviewed single‐institution retrospective data of 578 patients with clinically T1‐2N0M0 NSCLC treated by surgery or SBRT between 2004 and 2014, and extracted a cohort with borderline impaired PF for surgery, which was defined as predicted postoperative (PPO) forced expiratory volume in 1 s (FEV1) of <50% and ≥30%. Overall survival (OS), cancer‐specific survival (CSS), and disease‐free survival (DFS) were compared between surgery and SBRT using propensity score‐matching (PSM) to avoid bias. Results Among a total of 116 eligible patients with a median PPO FEV1 of 45%, PSM identified 25 patients from each group with similar characteristics. The median age, pretreatment FEV1, and follow‐up durations for the surgery and SBRT groups were 75 and 74 years, 58% and 56%, and 56 and 60 months, respectively. The 5‐year OS, CSS, and DFS rates of the surgery versus SBRT groups were 60% versus 63%, 76% versus 81%, and 52% versus 48%, respectively (p = 0.97, 0.81, and 0.99). The surgical mortality was 4.0%, but no treatment‐related death was observed after SBRT. The incidence of ≥ grade 2 adverse events after surgery was double that after SBRT (40% versus 20%, p = .22). Conclusion Our study suggests that SBRT is a reasonable option for patients with e‐stage NSCLC and impaired PF who are considered borderline candidates for surgery.

Clinical and dosimetric factors for symptomatic radiation pneumonitis after stereotactic body radiotherapy for early-stage non-small cell lung cancer

“…SBRT is the standard treatment for patients with medically inoperable early-stage NSCLC. Recently, evidence indicates that SBRT is a treatment option for operable early-stage NSCLC and oligometastatic lung tumors [2] , [3] , [4] .…”

Symptomatic radiation-induced rib fractures after stereotactic body radiotherapy for early-stage non-small cell lung cancer

“…Stereotactic body radiotherapy (SBRT) is a standard treatment option for patients with medically inoperable early-stage non-small cell lung cancer (NSCLC), offering the potential for better tumor control and longer overall survival. Recent findings highlighted SBRT as a treatment option for operable early-stage NSCLC and oligometastatic lung tumors, further emphasizing its importance [1] , [2] , [3] , [4] , [5] .…”

Local Recurrence Risk Score to Predict Relapse after Stereotactic Body Radiation Therapy for Lung Tumors

“…Unfortunately, randomized trials comparing surgery and SBRT closed early because of poor accrual [ 2 ]. The role of SBRT in the treatment of surgical candidates is under investigation and the proportion of borderline or potentially operable patients who receive SBRT for early-stage lung cancer is expected to increase [ 3 , 4 ]. Thanks to a biological equivalent dose exceeding 100 Gy, this technique has demonstrated a 3-year local control rate for early-stage, inoperable NSCLC of more than 90%.…”