Stereotactic Body Radiotherapy Versus Delayed Surgery for Early-stage Non-small-cell Lung Cancer

Abstract

Objective: To evaluate the overall survival of patients with operable stage IA non-small-cell lung cancer (NSCLC) who undergo “early” SBRT (within 0–30 days after diagnosis) versus “delayed” surgery (90–120 days after diagnosis). Summary of Background Data: During the COVID-19 pandemic, national guidelines have recommended patients with operable stage IA NSCLC to consider delaying surgery by at least 3 months or, alternatively, to undergo SBRT without delay. It is unknown which strategy is associated with better short- and long-term outcomes. Methods: Multivariable Cox proportional hazards modeling and propensity score-matched analysis was used to compare the overall survival of patients with stage IA NSCLC in the National Cancer Data Base from 2004 to 2015 who underwent “early” SBRT (0–30 days after diagnosis) versus that of patients who underwent “delayed” wedge resection (90–120 days after diagnosis). Results: During the study period, 570 (55%) patients underwent early SBRT and 475 (45%) underwent delayed wedge resection. In multivariable analysis, delayed resection was associated with improved survival [adjusted hazard ratio 0.61; (95% confidence interval (CI): 0.50–0.76)]. Propensity-score matching was used to create 2 groups of 279 patients each who received early SBRT or delayed resection that were well-matched with regard to baseline characteristics. The 5-year survival associated with delayed resection was 53% (95% CI: 45%–61%) which was better than the 5-year survival associated with early SBRT (31% [95% CI: 24%–37%]). Conclusion: In this national analysis, for patients with stage IA NSCLC, extended delay of surgery was associated with improved survival when compared to early treatment with SBRT.

Effect of COVID-19 on Thoracic Oncology Surgery in Spain: A Spanish Thoracic Surgery Society (SECT) Survey

“…As a result, cancer morbidity and mortality is expected to increase for years to come. Given the need to postpone surgery in these patients during the pandemic, some authors proposed SBRT as an alternative treatment in patients with early-stage lung cancer as a "bridge" until surgery could be performed [31]. However, to date, no clear guidelines have been proposed regarding the indications for these alternative therapeutic strategies-which are associated with worse outcomes-in part because the use of these alternative approaches require an individualised assessment by the MTB.…”

Imaging diagnosis of bronchogenic carcinoma (the forgotten disease) during times of COVID-19 pandemic: Current and future perspectives

“…Recommendations suggest using neoadjuvant therapy can achieve better prognosis in patients with bronchogenic carcinoma in whom surgical intervention has been postponed due to the above-mentioned reasons[ 61 ]. Home management including telemedicine limiting outpatient visits are recommended for cancer patients during this COVID-19 pandemic[ 62 ].…”

“…Stereotactic ablative radiotherapy and stereotactic body radiotherapy (SBRT) are non-invasive treatment strategies in the management of early stage (< 5 cm) node-negative NSCLC[ 61 , 62 ]. SBRT is a well-established, highly effective treatment modality with minimal risk and good local growth control of tumour[ 63 ].…”

A tolerability and safety analysis of adding granulocyte-macrophage colony-stimulating factor to local radiotherapy in a case series of seven patients with thoracic cancer

“…In the treatment of early-stage cancer, radiotherapy is a highly efficacious strategy. For patients with stage I non-small cell lung cancer (NSCLC), stereotactic body radiotherapy (SBRT) has shown comparable survival outcomes versus surgery (1). However, there is another voice demonstrating that the overall survival (OS) and disease-free survival (DFS) for patients with stage I NSCLC in the surgery group were slightly superior to those in the SBRT group (2).…”