Stereotactic Body Radiation Therapy Versus Surgery for Early Lung Cancer Among US Veterans

Bryant, Alex K.; Mundt, R.; Sandhu, Ajay; Urbanic, James J.; Sharabi, Andrew B.; Gupta, Samir; Daly, Megan E.; Murphy, James D.

doi:10.1016/j.athoracsur.2017.07.048

Cited by 60 publications

(53 citation statements)

References 30 publications

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“…3 At the same time, nonsurgical modalities, such as stereotactic body radiotherapy (SBRT), are increasingly being offered to patients with these small lesions, which may address the primary tumor but not the lymph nodes. 4 Previous prospective and retrospective studies of early-stage disease have varied in methodology and most often included patients with larger tumors up to 3 cm in diameter, reflecting prior classifications of what constitutes stage IA NSCLC. [5][6][7][8][9][10][11][12][13][14][15] Understanding the location in addition to the incidence of occult nodal metastases is crucial if we are to diverge from the traditional gold standard of lobectomy with complete lymphadenectomy.…”

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confidence: 99%

Prevalence of Occult Peribronchial N1 Nodal Metastasis in Peripheral Clinical N0 Small (≤2 cm) Non-Small Cell Lung Cancer

Robinson

Ilonen

Tan

et al. 2020

The Annals of Thoracic Surgery

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mentioning

confidence: 99%

Prevalence of Occult Peribronchial N1 Nodal Metastasis in Peripheral Clinical N0 Small (≤2 cm) Non-Small Cell Lung Cancer

Robinson

Ilonen

Tan

et al. 2020

The Annals of Thoracic Surgery

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“…Although a systematic review of studies using propensity score analyses reported better overall survival comparing sublobar resection with SBRT and no difference in lung cancer-specific survival, 12 a large analysis among US veterans reported no difference in cancer-specific survival, noncancer survival, and overall survival between patients treated with sublobar resection (n ¼ 634) and patients treated with SBRT (n ¼ 449). 23 In the near future, results from several randomized trials comparing sublobar resection with lobectomy will be reported.…”

Section: Bryan M Burt Mdmentioning

confidence: 99%

The American Society of Clinical Oncology–endorsed American Society for Radiation Oncology Evidence-Based Guideline of stereotactic body radiotherapy for early-stage non–small cell lung cancer: An expert opinion

Gückenberger

Aerts

Schil

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Feature Editor's Note-After reading this Feature Expert Opinion, it should be more evident than ever that lobectomy is the current standard of care for patients with stage I non-small cell lung cancer (NSCLC) who are medically fit for operation. It is common, however, for fit patients with stage I NSCLC to perceive stereotactic body radiotherapy (SBRT) as an attractive option for the treatment of their disease. SBRT is a noninvasive, well-tolerated outpatient procedure, and the Internet is replete with favorable efficacy statistics for SBRT that cannot be appropriately interpreted without a certain background in the field. As is common with all new and exciting technologies, innovation is provided with an opportunity to outpace the standard of care. SBRT for NSCLC is a relatively young and rapidly evolving modality of radiotherapy that has shown favorable results for control of the localized tumor mass in patients with stage I lung cancer who are not candidates for surgery. Consideration of SBRT to treat patients with stage I NSCLC who are medically fit for operation has resulted in the launching of 3 randomized controlled clinical trials (ROSEL, STARS, ACOSOG Z4099) comparing lobectomy with SBRT for operable stage I NSCLC, each of which closed prematurely because of poor accrual. In the absence of randomized data, 2 bodies of lower-level evidence literature on the comparative efficacies of surgery and SBRT for stage I lung cancer have emerged, one from the surgical community and one from the radiation oncology community. Sampling articles from each side of the aisle is an educational exercise that will benefit the reader's understanding of the disparities in outcomes reporting between each discipline and their implications for interpretation of results. Recently, the American Society for Radiation Oncology (ASTRO) published a refreshing evidence-based guideline on the role of SBRT in early stage NSCLC that was endorsed by the American Society of Clinical Oncology (ASCO). According to these guidelines, SBRT is not recommended as an alternative to surgery for patients with stage I NSCLC and standard operative risk, outside the context of a clinical trial. The Feature Expert Opinion article that follows is an interdisciplinary collaboration of surgery, radiation oncology, and pulmonology that will prime the readers on the most salient aspects of the ASTRO and ASCO guidelines for SBRT and offers a practical perspective for implementing these guidelines into practice. Bryan M. Burt, MDWe have witnessed controversies within the thoracic oncology community about the optimal treatment of early-stage non-small cell lung cancer (NSCLC), for which surgical lobectomy is challenged by stereotactic body radiotherapy (SBRT), and in the absence of randomized controlled trials, thoracic surgeons and radiation oncologists interpreted the available data in different ways. Therefore, the American Society for Radiation Oncology generated an evidence-based guideline on the role of SBRT in early-stage NSCLC: This guideline was From the

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“…The multivariable analysis considering long‐term survival found higher cancer‐specific mortality associated with SABR compared with lobectomy (hazard ratio 1.45, 95% CI: 1.09–1.94, P = 0.01). The mean age of this cohort was also under 75 years …”

Section: Discussionmentioning

confidence: 96%

“…The mean age of this cohort was also under 75 years. 45 Unlike current studies involving only T1 tumors, previously terminated randomized trials (the STARS trial [NCT00840749] and the ACOSOG Z4099 trial [NCT01336894]) and the presently recruiting randomized trials (the SABRTooth trial [NCT02629458] the VALOR trial [NCT02984761]) included both T1 and T2 (AJCC eighth) tumors to compare the outcomes of surgical resection and SABR. When SABR is delivered with the planning target volume receiving BED more than 100 Gy, good local control is achieved in not only T1 but also T2 tumors.…”

Section: Discussionmentioning

confidence: 99%

Lobectomy versus stereotactic ablative radiotherapy for medically operable patients with stage IA non‐small cell lung cancer: A virtual randomized phase III trial stratified by age

Seo

Kim

et al. 2019

Thoracic Cancer

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Background Although the choice between stereotactic ablative radiotherapy ( SABR) and lobectomy for early‐stage non‐small cell lung cancer (NSCLC) has been debated for years, the two procedures have not yet been directly compared in a randomized trial. We conducted a virtual randomized phase III trial stratified by age to compare the effectiveness of lobectomy and SABR for medically operable patients with stage IA (AJCC eighth) NSCLC using the Markov model analysis. Methods A Markov model was developed to simulate a cohort of patients aged 45–85 years with stage IA NSCLC who had undergone either lobectomy or SABR and were followed up for their remaining lifetime. Each virtual patient was randomly assigned to undergo lobectomy or SABR, and 10 000 patients were allocated to each group. All estimates of the variables were obtained by a systematic review of published articles. Results The lobectomy group showed a better life expectancy than the SABR group, in patients under 75 years of age. However, no statistically significant difference was seen in patients 75 years or older. The predicted life expectancy was 9.43 and 8.70 years in 75‐year‐old patients in the lobectomy and SABR groups, respectively. However, the 95%CI for the difference in life expectancy between the two groups was ‐ 0.06–1.50 years ( P = 0.0689). Conclusions The Markov model showed no statistically significant difference in the expected overall survival in stage IA NSCLC patients who were older than 75 years and had undergone SABR or lobectomy.

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Stereotactic Body Radiation Therapy Versus Surgery for Early Lung Cancer Among US Veterans

Cited by 60 publications

References 30 publications

Prevalence of Occult Peribronchial N1 Nodal Metastasis in Peripheral Clinical N0 Small (≤2 cm) Non-Small Cell Lung Cancer

Prevalence of Occult Peribronchial N1 Nodal Metastasis in Peripheral Clinical N0 Small (≤2 cm) Non-Small Cell Lung Cancer

The American Society of Clinical Oncology–endorsed American Society for Radiation Oncology Evidence-Based Guideline of stereotactic body radiotherapy for early-stage non–small cell lung cancer: An expert opinion

Lobectomy versus stereotactic ablative radiotherapy for medically operable patients with stage IA non‐small cell lung cancer: A virtual randomized phase III trial stratified by age

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