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J Thorac Cardiovasc Surg. 2016 Jul;152(1):44-54.e9. doi: 10.1016/j.jtcvs.2016.03.060. Epub 2016 Apr 7.

Lobectomy versus stereotactic body radiotherapy in healthy patients with stage I lung cancer.

Author information

1
Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn.
2
Yale School of Public Health, New Haven, Conn.
3
Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Conn.
4
Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn. Electronic address: Daniel.boffa@yale.edu.

Abstract

OBJECTIVES:

Stereotactic body radiotherapy is an effective treatment for patients with early-stage non-small cell lung cancer who are not healthy enough to undergo surgery; however, the relative efficacy versus surgery in healthy patients is unknown. The National Cancer Database contains information on patient health and eligibility for surgery, allowing the long-term survival associated with lobectomy and stereotactic body radiotherapy to be compared in healthy patients with clinical stage I disease.

METHODS:

The National Cancer Database was queried for patients who underwent lobectomy or stereotactic body radiotherapy for clinical stage I lung cancer between 2008 and 2012. Healthy patients were selected by excluding patients not offered surgery because of health-related reasons and only including patients documented to be free of comorbidities.

RESULTS:

A total of 13,562 comorbidity-free patients with clinical stage I lung cancer treated with lobectomy were compared with 1781 patients treated with stereotactic body radiotherapy. Time-stratified Cox proportional hazards models found lobectomy to be associated with a significantly better outcome than stereotactic body radiotherapy for both T1N0M0 tumors (hazard ratio, 0.38; 95% confidence interval, 0.33-0.43; P < .001) and T2N0M0 tumors 5 cm or less (hazard ratio, 0.38; confidence interval, 0.31-0.46; P < .001). In a propensity-matched analysis of 1781 pairs, lobectomy remained superior to stereotactic body radiotherapy (5-year survival 59% vs 29%, P < .001). Furthermore, when the subset of stereotactic patients who had refused a recommended surgery (n = 229) were propensity matched to lobectomy patients, lobectomy was associated with improved survival (5-year survival 58% vs 40%, P = .010).

CONCLUSIONS:

Among healthy patients with clinical stage I non-small cell lung cancer in the National Cancer Database, lobectomy is associated with a significantly better outcome than stereotactic body radiotherapy. Further study is warranted to clarify the comparative effectiveness of surgery and stereotactic body radiotherapy across various strata of patient health.

KEYWORDS:

NSCLC; SBRT; lobectomy; lung cancer; stereotactic body radiotherapy; survival

PMID:
27131846
DOI:
10.1016/j.jtcvs.2016.03.060
[Indexed for MEDLINE]
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