Timothy L McMurry1, Puja M Shah2, Pamela Samson3, Clifford G Robinson4, Benjamin D Kozower5. 1. Department of Public Health, University of Virginia, Charlottesville, Va. 2. Department of Surgery, University of Virginia, Charlottesville, Va. 3. Department of Surgery, Washington University, St Louis, Mo. 4. Department of Radiation Oncology, Washington University, St Louis, Mo. 5. Division of Cardiothoracic Surgery, Washington University, St Louis, Mo. Electronic address: kozowerb@wudosis.wustl.edu.
Abstract
OBJECTIVES: Stage I non-small cell lung cancer traditionally is treated with lobectomy. Sublobar resection and stereotactic body radiation therapy provide alternative treatments for higher-risk groups. The purpose of this study was to determine the national treatment trends for stage I lung cancer. METHODS: The National Cancer Database was queried for patients with clinical stage I non-small cell lung cancer between 1998 and 2012. Patients were compared across treatment groups, and trends in treatment and disease were evaluated over the 15-year time period. RESULTS: The National Cancer Database contained 369,931 patients with clinical stage I non-small cell lung cancer. After removing patients who received chemotherapy as a first course of treatment and patients with pathologic stage IV, 357,490 patients were analyzed. The first recorded cases of stereotactic body radiation therapy are in 2003 and rapidly increased to 6.6% (2063) of all patients treated in 2012. The number of diagnoses of stage I non-small cell lung cancer steadily increased over the 15-year period, whereas the rate of lobectomy decreased from 55% in 1998 to 50% in 2012 (P < .001). Most of the decrease in lobectomy can be explained by the increase in the rate of sublobar resection from 12% to 17% (P < .001). The percentage of untreated patients remained stable at approximately 7% (P = .283). CONCLUSIONS: Although the number of stage I non-small cell lung cancer cases continues to increase, lobectomy rates are decreasing while sublobar resection and stereotactic body radiation therapy rates are increasing. Although the increasing popularity of alternative therapies to lobectomy for treatment of stage I non-small cell lung cancer should allow more patients to undergo treatment, we did not observe this trend in the data.
OBJECTIVES: Stage I non-small cell lung cancer traditionally is treated with lobectomy. Sublobar resection and stereotactic body radiation therapy provide alternative treatments for higher-risk groups. The purpose of this study was to determine the national treatment trends for stage I lung cancer. METHODS: The National Cancer Database was queried for patients with clinical stage I non-small cell lung cancer between 1998 and 2012. Patients were compared across treatment groups, and trends in treatment and disease were evaluated over the 15-year time period. RESULTS: The National Cancer Database contained 369,931 patients with clinical stage I non-small cell lung cancer. After removing patients who received chemotherapy as a first course of treatment and patients with pathologic stage IV, 357,490 patients were analyzed. The first recorded cases of stereotactic body radiation therapy are in 2003 and rapidly increased to 6.6% (2063) of all patients treated in 2012. The number of diagnoses of stage I non-small cell lung cancer steadily increased over the 15-year period, whereas the rate of lobectomy decreased from 55% in 1998 to 50% in 2012 (P < .001). Most of the decrease in lobectomy can be explained by the increase in the rate of sublobar resection from 12% to 17% (P < .001). The percentage of untreated patients remained stable at approximately 7% (P = .283). CONCLUSIONS: Although the number of stage I non-small cell lung cancer cases continues to increase, lobectomy rates are decreasing while sublobar resection and stereotactic body radiation therapy rates are increasing. Although the increasing popularity of alternative therapies to lobectomy for treatment of stage I non-small cell lung cancer should allow more patients to undergo treatment, we did not observe this trend in the data.
Authors: Matthew P Smeltzer; Nicholas R Faris; Meredith A Ray; Carrie Fehnel; Cheryl Houston-Harris; Philip Ojeabulu; Olawale Akinbobola; Yu-Sheng Lee; Meghan Meadows; R Samuel Signore; Lynn Wiggins; David Talton; Edmond Owen; Lawrence E Deese; Richard Eubanks; Bradley A Wolf; Paul Levy; E Todd Robbins; Raymond U Osarogiagbon Journal: Ann Thorac Surg Date: 2018-12-27 Impact factor: 4.330
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