Multi-institutional analysis of stereotactic body radiation therapy for operable early-stage non-small cell lung carcinoma

• Published in: Radiotherapy and oncology Vol. 134; pp. 44 - 49
• Main Authors: Kann, Benjamin H., Verma, Vivek, Stahl, John M., Ross, Rudi, Dosoretz, Arie P., Shafman, Timothy D., Gross, Cary P., Park, Henry S., Yu, James B., Decker, Roy H.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-05-2019
• Subjects: Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - radiotherapy; Carcinoma, Non-Small-Cell Lung - surgery; Cohort Studies; Female; Humans; Kaplan-Meier Estimate; Lung cancer; Lung Neoplasms - pathology; Lung Neoplasms - radiotherapy; Lung Neoplasms - surgery; Male; Neoplasm Staging; Non-small cell lung carcinoma; Operable; Progression-Free Survival; Radiosurgery - methods; Retrospective Studies; Stereotactic ablative radiotherapy; Stereotactic body radiation therapy; Treatment Outcome; Non-small cell lung carcinoma; Stereotactic body radiation therapy; Operable; Stereotactic ablative radiotherapy; Lung cancer
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2019.01.027

•SBRT remains controversial for operable early-stage NSCLC.•This study analyzes a cohort of >400 operable patients treated with SBRT.•Disease control outcomes for operable and inoperable SBRT patients are similar.•Operable SBRT patients have improved survival compared to inoperable patients.
Although stereotactic body radiation therapy (SBRT) is the standard of care for inoperable early-stage non-small cell lung carcinoma (NSCLC), its role for medically operable patients remains controversial. To address this knowledge gap, we conducted a multi-institutional study to assess post-SBRT disease control and survival outcomes in medically operable patients.
We conducted a retrospective cohort study including patients with biopsy-proven cT1-2N0M0 NSCLC treated with definitive SBRT (2006–2015). Per patient charts, inoperability referred to documentation of poor surgical candidacy with a given rationale for lack of resection. Charts of operable patients contained documentation of patients refusing surgery or choosing SBRT, without a documented rationale for inoperability. Subjects were excluded in cases of ambiguity regarding the aforementioned definitions and/or lack of clearly documented operability status. Endpoints included local failure (LF) and regional-distant failure, both evaluated with Fine and Gray competing risks regression; Kaplan-Meier methodology analyzed overall survival (OS) and progression-free survival (PFS).
Of 952 patients, 408 (42.9%) were operable, and 544 (57.1%) were inoperable. Median follow-up was 22 months. Two-year LF was 9.7% in operable patients and 8.2% in inoperable patients (p = 0.36). There was no statistical difference in regional-distant failure (p = 0.55) between cohorts. Operable patients experienced statistically higher OS (p = 0.04), but not PFS (p = 0.11). Respective 1-, 2-, and 3-year OS in operable patients were 85.4%, 66.2%, and 51.2%.
Although patients with operable NSCLC experience higher OS than their inoperable counterparts, disease-related outcomes are similar. These results may better inform shared decision-making between medically operable patients and their multidisciplinary providers.