As a result of the COVID-19 pandemic, national guidelines suggested that patients with operable stage IA non-small cell lung cancer (NSCLC) delay surgery by at least 3 months, or undergo stereotactic body radiotherapy (SBRT) without delay. A recently published study showed that extended delay of surgery was associated with improved survival compared with early SBRT.
The study included patients with stage IA NSCLC diagnosed between 2004 and 2015 taken from the National Cancer Database. Early SBRT (n=570) was defined as receipt from 0 to 30 days after diagnosis; delayed wedge resection (n=475) occurred 90 to 120 days after diagnosis. Patients who received SBRT because their physician thought surgery was contraindicated were excluded.
Compared with patients who had early SBRT, patients who had delayed wedge resection were younger, less likely to be White, had a higher comorbidity score, were less likely to have T1c tumors, and more likely to have histology of adenocarcinoma.
A multivariable analysis showed that wedge resection was associated with improved survival compared with early SBRT (adjusted hazard ratio, 0.61; 95% CI, 0.50-0.76; P <.001).
The researchers then used propensity-score matching to create 2 groups of 279 patients well matched for baseline characteristics but who underwent different treatment. The 5-year survival associated with delayed resection was 53% compared with 31% for early SBRT.
“The present study findings suggest that, in the setting of the COVID pandemic, if a patient has stage IA NSCLC and cannot readily and safely undergo surgery immediately, then waiting for surgery 3 to 4 months after diagnosis is a strategy that can be carefully considered in a multidisciplinary setting,” the researchers concluded.
Mayne NR, Lin BK, Darling AJ, et al. Stereotactic body radiotherapy versus delayed surgery for early-stage non-small-cell lung cancer. Ann Surg. 2020;272(6):925-929. doi:10.1097/SLA.0000000000004363