Multi-institutional analysis of stereotactic body radiation therapy for operable early-stage non-small cell lung carcinoma. (May 2019)

• Record Type: Journal Article
• Authors: Kann, Benjamin H.; Verma, Vivek; Stahl, John M.; Ross, Rudi; Dosoretz, Arie P.; Shafman, Timothy D.; Gross, Cary P.; Park, Henry S.; Yu, James B.; Decker, Roy H.
• Is Part Of: Radiotherapy and oncology. Volume 134(2019)
• Page Start: 44
• Page End: 49
• Publication Date: 2019-05
• Subjects: Stereotactic body radiation therapy -- Stereotactic ablative radiotherapy -- Lung cancer -- Non-small cell lung carcinoma -- Operable; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2019.01.027
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: SBRT remains controversial for operable early-stage NSCLC. This study analyzes a cohort of >400 operable patients treated with SBRT. Disease control outcomes for operable and inoperable SBRT patients are similar. Operable SBRT patients have improved survival compared to inoperable patients. Abstract: Purpose: Although stereotactic body radiation therapy (SBRT) is the standard of care for inoperable early-stage non-small cell lung carcinoma (NSCLC), its role for medically operable patients remains controversial. To address this knowledge gap, we conducted a multi-institutional study to assess post-SBRT disease control and survival outcomes in medically operable patients. Methods: We conducted a retrospective cohort study including patients with biopsy-proven cT1-2N0M0 NSCLC treated with definitive SBRT (2006–2015). Per patient charts, inoperability referred to documentation of poor surgical candidacy with a given rationale for lack of resection. Charts of operable patients contained documentation of patients refusing surgery or choosing SBRT, without a documented rationale for inoperability. Subjects were excluded in cases of ambiguity regarding the aforementioned definitions and/or lack of clearly documented operability status. Endpoints included local failure (LF) and regional-distant failure, both evaluated with Fine and Gray competing risks regression; Kaplan-Meier methodology analyzed overall survival (OS) and progression-free survival (PFS). Results: Of 952 patients, 408 (42.9%) were operable, and 544 (57.1%) were inoperable. Median follow-up was 22 months. Two-year LF was 9.7% in operable patients and 8.2% in inoperable patients (p = 0.36). There was no statistical difference in regional-distant failure (p = 0.55) between cohorts. Operable patients experienced statistically higher OS (p = 0.04), but not PFS (p = 0.11). Respective 1-, 2-, and 3-year OS in operable patients were 85.4%, 66.2%, and 51.2%. Conclusions: Although patients with operable NSCLC experience higher OS than their inoperable counterparts, disease-related outcomes are similar. These results may better inform shared decision-making between medically operable patients and their multidisciplinary providers.