Sublobar Resection Versus Stereotactic Body Radiation Therapy for Clinical Stage I Non-Small Cell Lung Cancer: A Study Using Data from the Korean Nationwide Lung Cancer Registry

• Published in: Cancer research and treatment Vol. 55; no. 4; pp. 1171 - 1180
• Main Authors: Yun, Jeonghee, Cho, Jong Ho, Hong, Tae Hee, Yang, Kyungmi, Ahn, Yong Chan, Kim, Hong Kwan
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Cancer Association 01-10-2023; 대한암학회
• Subjects: Original; 의학일반; Sublobar resection; Non-small cell lung cancer; Radiosurgery
• ISSN: 1598-2998; 2005-9256
• DOI: 10.4143/crt.2022.1581

Stereotactic body radiotherapy (SBRT) had been increasingly recognized as a favorable alternative to surgical resection in patients with high risk for surgery. This study compared survival outcomes between sublobar resection (SLR) and SBRT for clinical stage I non-small cell lung cancer (NSCLC).
Data were obtained from the Korean Association of Lung Cancer Registry, a sampled nationwide database. This study retrospectively reviewed 382 patients with clinical stage I NSCLC who underwent curative SLR or SBRT from 2014 to 2016.
Of the patients, 43 and 339 underwent SBRT and SLR, respectively. Patients in the SBRT group were older and had worse pulmonary function. The 3-year OS rate was significantly better in the SLR group compared with the SBRT group (86.6% vs. 57%; log-rank p<0.001). However, after adjusting for age, sex, tumor size, pulmonary function, histology, smoking history, and adjuvant therapy, treatment modality was not an independent prognostic factor for survival (hazard ratio 0.99, 95% confidence interval 0.43-2.77; p=0.974). We performed subgroup analysis in the following high-risk populations: (1) patients who were older than 75 years; (2) patients who were older than 70 years and had DLCO ≤80%. In each subgroup, there were no differences in OS and RFS between patients who underwent SLR and those who received SBRT.
In our study, there was no significant differences in terms of survival or recurrence between SBRT and SLR in medically compromised stage I NSCLC patients. Our findings suggest that SBRT could be considered as a potential treatment option for selected patients.