Stereotactic body radiation therapy versus sublobar resection for stage I NSCLC. (November 2018)

• Record Type: Journal Article
• Authors: Ackerson, Bradley G.; Tong, Betty C.; Hong, Julian C.; Gu, Lin; Chino, Junzo; Trotter, Jacob W.; D'Amico, Thomas A.; Torok, Jordan A.; Lafata, Kyle; Chang, Catherine; Kelsey, Chris R
• Is Part Of: Lung cancer. Volume 125(2018)
• Page Start: 185
• Page End: 191
• Publication Date: 2018-11
• Subjects: Lung cancer -- Non-small cell lung cancer -- Stereotactic body radiation therapy -- Surgery -- Sublobar resection; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2018.09.020
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: Sublobar resection and SBRT for stage I NSCLC have not been compared in randomized trials. In our center's experience, these modalities had similar rates of local tumor control. Overall survival favored surgery, but the surgical cohort had less co-morbidities. After correcting for baseline imbalances, overall survival was similar. SBRT and sublobar resection are both suitable options for stage I NSCLC. Abstract: Purpose: To compare sublobar resection and stereotactic body radiation therapy (SBRT) in patients with stage I non-small cell lung cancer (NSCLC). Methods: Patients undergoing sublobar resection or SBRT for stage I NSCLC from 2007 to 2014 at Duke University Medical Center were evaluated. The primary endpoint of interest was freedom from local recurrence. Kaplan-Meier survival estimates and Cox proportional hazards multivariate analyses were performed. Results: 221 patients with stage I NSCLC undergoing sublobar resection (n = 151; 105 wedge and 46 segmentectomy) or SBRT (n = 70) were evaluated. The majority (89%) of patients receiving SBRT were medically inoperable, and compared with surgical patients, were significantly older (74 vs 70 years, p = 0.019), had higher Charlson Comorbidity Indices (3.7 vs 2.7, p < 0.001), larger tumors (2.4 cm vs 1.7 cm, p < 0.001), and worse baseline pulmonary function. At 3 years, freedom from local recurrence was 90% (95% CI 82–94%) for surgery and 85% (95% CI 65–94%) for SBRT (p = 0.71). While overall survival and disease-free survival were higher in the surgical cohort, no differences were noted in cancer-specific disease-free survival (60% vs. 65%, p = 0.84). On multivariate analysis, higher Charlson Comorbidity Index (HR 1.38, 95% CI 1.19–1.61, p < 0.001) and lower diffusion capacity (HR 0.97, 95% CI 0.96-0.98, p < 0.001) were independently associated with inferior overall survival. No differences in overall survival between surgery and SBRT (HR 1.20, 95% CI 0.74–1.95, p = 0.46) were observed after correcting for baseline imbalances in prognostic factors. Conclusions: SBRT and sublobar resection provided similar rates of local tumor control and overall clinical outcomes in stage I NSCLC.