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Ann Thorac Surg. 2018 Nov 17. pii: S0003-4975(18)31664-3. doi: 10.1016/j.athoracsur.2018.10.015. [Epub ahead of print]

Comparison between Stereotactic Radiotherapy and Sublobar Resection for Non-Small Cell Lung Cancer.

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Department of Thoracic, Cardiovascular and General Surgery, Kanazawa University, Kanazawa, Japan. Electronic address:
Department of Thoracic, Cardiovascular and General Surgery, Kanazawa University, Kanazawa, Japan.
Department of Radiotherapy, Kanazawa University, Kanazawa, Japan.
Department of Surgery, Fukui Prefectural Hospital, Fukui, Japan.
Department of Radiology, Fukui Prefectural Hospital, Fukui, Japan.
Department of Radiology, Asanogawa General Hospital, Kanazawa, Japan.



The aim of this study was to compare outcomes of primary treatment with stereotactic body radiation therapy (SBRT) versus sublobar resection (SLR) for clinical stage I non-small cell lung cancer (NSCLC) in patients with medical comorbidities.


Consecutive patients who underwent SBRT (n=106) or SLR (wedge resection: n=100 and segmentectomy: n=41) because of medical comorbidities associated with stage I NSCLC were enrolled. Lesions located in the outer third of the lung field on CT were defined as external, and others were defined as internal. A propensity matched analysis was also performed that compared SBRT and SLR results. Charts were reviewed to determine local tumor recurrence, disease-specific survival (DSS), and overall survival (OS).


A propensity matched analysis, recurrence-free survival (RFS) became significant in favor of surgery (p=0.036). For large nodules of >2.0 cm in diameter, RFS was significantly better in the surgery group (p=0.042). No significant differences in OS, DSS, or RFS were observed with small nodules of <2.0 cm in diameter. In the external group, a higher recurrence rate was seen for SBRT group. For internal group, there was no statistical difference between each treatment. Local recurrence rate was higher in the SBRT group (p=0.0082) in the external group.


In a matched comparison of stage I NSCLC in patients with medical comorbidities, RFS was in favor of surgery comparing SBRT, but there were no significant differences in OS or DSS. The tumor size, tumor location should be considered before deciding whether to perform SBRT or surgery.


Non-small cell lung cancer; Surgery; propensity score matching; stereotactic body radiation therapy (SBRT)

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