Matthew Koshy1, Renuka Malik2, Usama Mahmood3, Zain Husain4, David J Sher5. 1. Department of Radiation Oncology, University of Illinois at Chicago, USA; Department of Radiation and Cellular Oncology, The University of Chicago, USA. Electronic address: mkoshy@radonc.uchicago.edu. 2. Department of Radiation and Cellular Oncology, The University of Chicago, USA. 3. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. 4. Department of Radiation Oncology, Yale University, USA. 5. Department of Radiation Oncology, Rush University Medical Center, Chicago, USA.
Abstract
BACKGROUND: This study examined the comparative effectiveness of no treatment (NoTx), conventional fractionated radiotherapy (ConvRT), and stereotactic body radiotherapy (SBRT) in patients with inoperable stage I non-small cell lung cancer. This population based cohort also allowed us to examine what facility level characteristics contributed to improved outcomes. METHODS: We included patients in the National Cancer Database from 2003 to 2006 with T1-T2N0M0 inoperable lung cancer (n=13,036). Overall survival (OS) was estimated using Kaplan-Meier methods and Cox proportional hazard regression. RESULTS: The median follow up was 68months (interquartile range: 35-83months) in surviving patients. Among the cohort, 52% received NoTx, 41% received ConvRT and 6% received SBRT. The 3-year OS was 28% for NoTx, 36% for ConvRT radiotherapy, and 48% for the SBRT cohort (p<0.0001). On multivariate analysis, the hazard ratio for SBRT and ConvRT were 0.67 and 0.77, respectively, as compared to NoTx (1.0 ref) (p<0.0001). Patients treated at a high volume facility vs. low volume facility had a hazard ratio of 0.94 vs. 1.0 (p=0.01). CONCLUSIONS: Patients with early stage inoperable lung cancer treated with SBRT and at a high volume facility had a survival benefit compared to patients treated with ConvRT or NoTx or to those treated at a low volume facility.
BACKGROUND: This study examined the comparative effectiveness of no treatment (NoTx), conventional fractionated radiotherapy (ConvRT), and stereotactic body radiotherapy (SBRT) in patients with inoperable stage I non-small cell lung cancer. This population based cohort also allowed us to examine what facility level characteristics contributed to improved outcomes. METHODS: We included patients in the National Cancer Database from 2003 to 2006 with T1-T2N0M0 inoperable lung cancer (n=13,036). Overall survival (OS) was estimated using Kaplan-Meier methods and Cox proportional hazard regression. RESULTS: The median follow up was 68months (interquartile range: 35-83months) in surviving patients. Among the cohort, 52% received NoTx, 41% received ConvRT and 6% received SBRT. The 3-year OS was 28% for NoTx, 36% for ConvRT radiotherapy, and 48% for the SBRT cohort (p<0.0001). On multivariate analysis, the hazard ratio for SBRT and ConvRT were 0.67 and 0.77, respectively, as compared to NoTx (1.0 ref) (p<0.0001). Patients treated at a high volume facility vs. low volume facility had a hazard ratio of 0.94 vs. 1.0 (p=0.01). CONCLUSIONS:Patients with early stage inoperable lung cancer treated with SBRT and at a high volume facility had a survival benefit compared to patients treated with ConvRT or NoTx or to those treated at a low volume facility.
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