Stereotactic body radiotherapy versus percutaneous local tumor ablation for early-stage non-small cell lung cancer. (December 2019)

• Record Type: Journal Article
• Authors: Ager, Bryan J.; Wells, Stacey M.; Gruhl, Joshua D.; Stoddard, Gregory J.; Tao, Randa; Kokeny, Kristine E.; Hitchcock, Ying J.
• Is Part Of: Lung cancer. Volume 138(2019)
• Page Start: 6
• Page End: 12
• Publication Date: 2019-12
• Subjects: NSCLC non-small cell lung cancer -- SBRT stereotactic body radiotherapy -- LTA local tumor ablation -- RFA radiofrequency ablation -- OS overall survivor -- NCDB National Cancer Database -- ICD-O International Classification of Diseases in Oncology -- AJCC American Joint Committee on Cancer -- T tumor -- Gy gray; NSCLC -- Stereotactic body radiotherapy -- Percutaneous ablation -- Radiofrequency ablation -- Microwave ablation; 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.2019.09.009
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: SBRT was much more common (93%) than percutaneous local tumor ablation (LTA)(7%). Higher OS was associated with SBRT versus percutaneous LTA in early-stage NSCLC. The OS benefit to SBRT was consistent across multiple patient subsets. Patients with tumor sizes ≤2.0 cm had similar OS between treatments. Abstract: Objectives: To compare patterns of care and overall survival (OS) between stereotactic body radiotherapy (SBRT) and percutaneous local tumor ablation (LTA) for non-surgically managed early-stage non-small-cell lung cancer (NSCLC). Materials and methods: The National Cancer Database (NCDB) was queried from 2004 to 2014 for adults with non-metastatic, node-negative invasive adenocarcinoma or squamous cell carcinoma of the lung with primary tumor size ≤5.0 cm who did not undergo surgery or chemotherapy and received SBRT or LTA. Patterns of care were assessed with multivariate logistic regression. After propensity-score weighting with generalized boosted regression, OS was assessed with univariate and doubly-robust multivariate Cox regression. Results: Of 15, 792 patients, 14, 651 (93%) received SBRT and 1141 (7%) received LTA. Increasing age (OR 1.01, p = .035), treatment at an academic institution (OR 2.94, p < .001), increasing tumor size (OR 1.05, p < .001), and more recent year of diagnosis (OR 1.43, p < .001) were predictive of treatment with SBRT, whereas comorbidities (OR 0.74, p = .003) and treatment at a high-volume facility (OR 0.05, p < .001) were predictive for LTA. At a median follow-up of 26.2 months, SBRT was associated with improved OS relative to LTA within a propensity-score weighted doubly-robust multivariate analysis (HR 0.71, p < .001). On weighted subgroup analyses, improved OS was observed with SBRT for tumor sizes >2.0 cm (HR 0.72, p < .001) and for those treated at high-volume facilities (HR 0.71, p < .001). No OS difference was found with SBRT or LTA in tumor sizes ≤2.0 cm (HR 0.90, p = .227). Conclusion: Within the NCDB, SBRT was more commonly utilized and was associated with improved OS when compared to percutaneous LTA for patients with non-surgically managed early-stage NSCLC. Patients with small tumor volumes likely represent an appropriate population for future prospective randomized comparisons between SBRT and LTA.