Surgery May Be Superior to Stereotactic Body Radiation Therapy for Early Stage NSCLC

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SBRT provides excellent local control and an adequate safety profile, but there is a lack of data comparing SBRT to resection among patients eligible for surgery.
SBRT provides excellent local control and an adequate safety profile, but there is a lack of data comparing SBRT to resection among patients eligible for surgery.

Lobectomy — but not sublobar resection — may improve survival outcomes compared with stereotactic body radiation therapy (SBRT) among patients with early stage non–small cell lung cancer (NSCLC), according to a study published in the Annals of Thoracic Surgery.1

For a subset of patients with NSCLC unable to undergo resection, SBRT has become the treatment of choice. SBRT provides excellent local control and an adequate safety profile, but there is a lack of data comparing SBRT to resection among patients eligible for surgery.

For this retrospective study, researchers identified 4069 patients with early stage NSCLC from the Veteran's Affairs Informatics and Computing Infrastructure (VINCI) who received surgery or radiation therapy. Investigators evaluated the cancer-specific survival of 449, 2986, and 634 patients who had undergone SBRT, lobectomy, and sublobar resection, respectively.

The median follow-up was 1.5 years for SBRT, 2.9 years for lobectomy, and 2.6 years for sublobar resection. Unadjusted analysis revealed that patients who underwent surgery had greater immediate post-procedural mortality, but multivariate analysis adjusted for long-term survival showed that cancer-specific mortality was greater among patients who received SBRT by nearly 45% compared with those who underwent lobectomy (subdistribution hazard ratio [HR], 1.45; 95% CI, 1.09-1.94; P = .01).

No differences in survival were, however, observed between SBRT and sublobar resection (subdistribution HR, 1.25; 95% CI, 0.93-1.68; P = .15).

The authors noted these findings suggest that aggressive local treatment may be more beneficial in early disease, but concluded that “[d]espite these findings, the potential for unmeasured confounding remains and prospective randomized trials are needed to better compare these treatment modalities.”

Reference

  1. Bryant AK, Mundt RC, Sandhu AP, et al. Stereotactic body radiation therapy versus surgery for early lung cancer among US veterans. Ann Thorac Surg. 2017 Nov 29. doi:  10.1016/j.athoracsur.2017.07.048 [Epub ahead of print]

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