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Ann Thorac Surg. 2015 Apr;99(4):1122-9. doi: 10.1016/j.athoracsur.2014.11.009. Epub 2015 Feb 7.

Video-assisted thoracoscopic lobectomy versus stereotactic radiotherapy for stage I lung cancer.

Author information

1
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto.
2
Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto.
3
Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto.
4
Department of Radiation Oncology, Graduate School of Medicine, Hiroshima University, Hiroshima, Japan.
5
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto. Electronic address: hdate@kuhp.kyoto-u.ac.jp.

Abstract

BACKGROUND:

Previous comparative reports of stereotactic body radiotherapy (SBRT) and surgery for non-small cell lung cancer (NSCLC) suffered from short follow-up, mixed extents of resection and inclusion of benign lesion. We aimed to make comparisons of long-term outcomes between a pure series of video-assisted thoracoscopic surgery (VATS) lobectomy and SBRT for biopsy-proven clinical stage I NSCLC.

METHODS:

We retrospectively compared overall survival (OS), cause-specific survival (CSS), recurrence-free survival (RFS), local control, regional lymph node (LN) control, and distant control between VATS lobectomy (n = 413) and SBRT (n = 104) for biopsy-proven clinical stage I NSCLC at our institution between 2003 and 2009. Propensity score matching was used to adjust the confounding effects in estimating treatment hazard ratios. Forty-one VATS lobectomy patients and 41 SBRT patients were matched blinded to outcome (1:1 ratio, caliper distance; 0.5).

RESULTS:

After propensity score matching, the follow-up period of the whole cohort ranged from 5 to 120 months with a median of 48. After propensity score matching there were significant differences in OS (p = 0.0016), CSS (p = 0.0015), RFS (p < 0.0001), local control (p = 0.0019), and distant control (p < 0.0001) and no significant difference in regional LN control (p = 0.11). The VATS lobectomy patients and SBRT patients had 68.5% and 37.3% of 5-year OS, 83.5% and 56.7% of 5-year CSS, and 60.4% and 19.5% of 5-year RFS, respectively.

CONCLUSIONS:

Our results suggest VATS lobectomy may offer significantly more favorable long-term outcomes than SBRT in potentially operable patients with biopsy-proven clinical stage I NSCLC.

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