Treatment Outcomes in Stage I Lung Cancer

Abstract

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.

Video-Assisted Thoracoscopic Lobectomy Versus Stereotactic Body Radiotherapy Treatment for Early-Stage Non-Small Cell Lung Cancer: A Propensity Score-Matching Analysis

“…It's worth noting that our outcomes contradict to some of the recent suggestion that lobectomy is superior to SBRT. In some retrospective studies, patients selected for VATS have improved survival compared with SBRT (29)(30)(31)(32)(33). In these studies, routine systematic mediastinal lymph node dissection identified candidates for adjuvant chemotherapy, which may be associated with a significant difference in OS and CSS.…”

Surgical quality of wedge resection affects overall survival in patients with early stage non–small cell lung cancer

“…5,6 Outcome measures between wedge resection and SBRT have been evaluated in a number of observational studies. [24][25][26][27][28][29] Many of these studies have shown superior overall survival among surgical patients but were underpowered and lacked statistical significance. A notable exception is the recent analysis of the NCDB by Yerokun et al, who reported wedge resection to be significantly superior to SBRT for 5-year overall survival (31.0% for SBRT vs 49.9% for wedge resection; P < .001).…”

Treatment, no treatment and early death in Danish stage I lung cancer patients

“…Under consideration of their general condition, it is pivotal for the prognosis that the patients receive the most effective and safest treatment modality 6,7 . For early stage lung cancer, several treatment options exist and surgery is associated with the most favourable outcome 8,9 . However, stereotactic body radiotherapy is an effective alternative, particularly for patients that are medically unfit for surgery 10,11 .…”