A comparison between accelerated hypofractionation and stereotactic ablative radiotherapy (SABR) for early-stage non-small cell lung cancer (NSCLC): Results of a propensity score-matched analysis. Issue 3 (March 2016)

• Record Type: Journal Article
• Authors: Chiang, Andrew; Thibault, Isabelle; Warner, Andrew; Rodrigues, George; Palma, David; Soliman, Hany; Jain, Suneil; Poon, Ian; Cheung, Patrick
• Is Part Of: Radiotherapy and oncology. Volume 118:Issue 3(2016:Mar.)
• Page Start: 478
• Page End: 484
• Publication Date: 2016-03
• Subjects: Accelerated hypofractionation -- Stereotactic radiotherapy -- Lung cancer; 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.2015.12.026
• Languages: English
• ISSNs: 0167-8140

Abstract

Abstract: Background and purpose: Stereotactic ablative radiotherapy (SABR) has become standard for inoperable early-stage non-small cell lung cancer (NSCLC). However, there is no randomized evidence demonstrating benefit over more fractionated radiotherapy. We compared accelerated hypofractionation (AH) and SABR using a propensity score-matched analysis. Materials and methods: From 1997–2007, 119 patients (T1–3N0M0 NSCLC) were treated with AH (48–60 Gy, 12–15 fractions). Prior to SABR, this represented our institutional standard. From 2008–2012, 192 patients (T1–3N0M0 NSCLC) were treated with SABR (48–52 Gy, 4–5 fractions). A total of 114 patients (57 per cohort) were matched (1:1 ratio, caliper: 0.10) using propensity scores. Results: Median follow-up (range) for the AH cohort was 36.3 (2.5–109.1) months, while that for the SABR group was 32.5 (0.3–62.6) months. Three-year overall survival (OS) and local control (LC) rates were 49.5% vs. 72.4% [ p = 0.024; hazard ratio (HR): 2.33 (1.28, 4.23), p = 0.006] and 71.9% vs. 89.3% [ p = 0.077; HR: 5.56 (1.53, 20.2), p = 0.009], respectively. On multivariable analysis, tumour diameter and PET staging were predictive for OS, while the only predictive factor for LC was treatment cohort. Conclusions: OS and LC were improved with SABR, although OS is more closely related to non-treatment factors. This represents one of the few studies comparing AH to SABR for early-stage lung cancer.