Peter Paximadis1, Jennifer L Beebe-Dimmer2, Julie George2, Anne G Schwartz2, Antoinette Wozniak2, Shirish Gadgeel3. 1. Department of Radiation Oncology, Lakeland Health, St Joseph, MI. Electronic address: ppaximadis1@lakelandhealth.org. 2. Department of Oncology, Wayne State University School of Medicine and the Karmanos Cancer Center, Detroit, MI. 3. Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
Abstract
INTRODUCTION: The diagnosis of stage I small-cell lung cancer (SCLC) is increasing in incidence with the advent of low-dose screening computed tomography. Surgery is considered the standard of care but there are very few data to guide clinical decision-making. The purpose of this study was to compare outcomes for patients receiving definitive surgery, stereotactic body radiation therapy (SBRT), or external beam radiation therapy (EBRT) for stage I SCLC. PATIENTS AND METHODS: Patients with a primary diagnosis of stage I SCLC were identified in the National Cancer Database. Patients were defined as having a first course of treatment of either surgery, EBRT, or SBRT. Overall survival (OS) was determined using the Kaplan-Meier method and Cox proportional hazards regression methods were used to estimate risk of overall mortality. RESULTS: A total of 2678 patients were included in the analysis. The 2- and 3-year OS for the whole cohort was 62% and 50%. Comparing treatment strategies in a multivariate model, surgical resection showed improved OS over EBRT (P < .001) and SBRT (P < .001), however, the OS benefit over SBRT did not persist for patients who underwent limited resection. When excluding patients who underwent surgery, SBRT showed improved OS compared with EBRT (P = .04). Additional use of chemotherapy with any treatment modality resulted in improved OS (P < .001). CONCLUSION: In this hospital-based registry study, definitive surgical resection and use of chemotherapy resulted in improved survival for patients with early stage SCLC. For patients who are not candidates for surgery, SBRT may offer a survival benefit compared with standard EBRT.
INTRODUCTION: The diagnosis of stage I small-cell lung cancer (SCLC) is increasing in incidence with the advent of low-dose screening computed tomography. Surgery is considered the standard of care but there are very few data to guide clinical decision-making. The purpose of this study was to compare outcomes for patients receiving definitive surgery, stereotactic body radiation therapy (SBRT), or external beam radiation therapy (EBRT) for stage I SCLC. PATIENTS AND METHODS: Patients with a primary diagnosis of stage I SCLC were identified in the National Cancer Database. Patients were defined as having a first course of treatment of either surgery, EBRT, or SBRT. Overall survival (OS) was determined using the Kaplan-Meier method and Cox proportional hazards regression methods were used to estimate risk of overall mortality. RESULTS: A total of 2678 patients were included in the analysis. The 2- and 3-year OS for the whole cohort was 62% and 50%. Comparing treatment strategies in a multivariate model, surgical resection showed improved OS over EBRT (P < .001) and SBRT (P < .001), however, the OS benefit over SBRT did not persist for patients who underwent limited resection. When excluding patients who underwent surgery, SBRT showed improved OS compared with EBRT (P = .04). Additional use of chemotherapy with any treatment modality resulted in improved OS (P < .001). CONCLUSION: In this hospital-based registry study, definitive surgical resection and use of chemotherapy resulted in improved survival for patients with early stage SCLC. For patients who are not candidates for surgery, SBRT may offer a survival benefit compared with standard EBRT.
Authors: Robert Timmerman; Rebecca Paulus; James Galvin; Jeffrey Michalski; William Straube; Jeffrey Bradley; Achilles Fakiris; Andrea Bezjak; Gregory Videtic; David Johnstone; Jack Fowler; Elizabeth Gore; Hak Choy Journal: JAMA Date: 2010-03-17 Impact factor: 56.272
Authors: Achilles J Fakiris; Ronald C McGarry; Constantin T Yiannoutsos; Lech Papiez; Mark Williams; Mark A Henderson; Robert Timmerman Journal: Int J Radiat Oncol Biol Phys Date: 2009-02-27 Impact factor: 7.038
Authors: John M Stahl; Christopher D Corso; Vivek Verma; Henry S Park; Sameer K Nath; Zain A Husain; Charles B Simone; Anthony W Kim; Roy H Decker Journal: Lung Cancer Date: 2016-11-16 Impact factor: 5.705
Authors: Bruno R Bastos; Georges F Hatoum; Gail R Walker; Khaled Tolba; Christiane Takita; Jorge Gomez; Edgardo S Santos; Gilberto Lopes; Luis E Raez Journal: J Thorac Oncol Date: 2010-04 Impact factor: 15.609
Authors: Chi-Fu Jeffrey Yang; Derek Y Chan; Paul J Speicher; Brian C Gulack; Xiaofei Wang; Matthew G Hartwig; Mark W Onaitis; Betty C Tong; Thomas A D'Amico; Mark F Berry; David H Harpole Journal: J Clin Oncol Date: 2016-01-19 Impact factor: 44.544
Authors: Joe Y Chang; Suresh Senan; Marinus A Paul; Reza J Mehran; Alexander V Louie; Peter Balter; Harry J M Groen; Stephen E McRae; Joachim Widder; Lei Feng; Ben E E M van den Borne; Mark F Munsell; Coen Hurkmans; Donald A Berry; Erik van Werkhoven; John J Kresl; Anne-Marie Dingemans; Omar Dawood; Cornelis J A Haasbeek; Larry S Carpenter; Katrien De Jaeger; Ritsuko Komaki; Ben J Slotman; Egbert F Smit; Jack A Roth Journal: Lancet Oncol Date: 2015-05-13 Impact factor: 41.316
Authors: Zaheer Ahmed; Lara Kujtan; Kevin F Kennedy; John R Davis; Janakiraman Subramanian Journal: Clin Lung Cancer Date: 2017-03-30 Impact factor: 4.785
Authors: Margreet Lüchtenborg; Sharma P Riaz; Eric Lim; Richard Page; David R Baldwin; Erik Jakobsen; Peter Vedsted; Mike Lind; Michael D Peake; Anders Mellemgaard; James Spicer; Loic Lang-Lazdunski; Henrik Møller Journal: Thorax Date: 2013-10-30 Impact factor: 9.139
Authors: Vignesh Raman; Oliver K Jawitz; Chi-Fu Jeffrey Yang; Soraya L Voigt; Thomas A D'Amico; David H Harpole; Betty C Tong Journal: J Thorac Cardiovasc Surg Date: 2020-03-22 Impact factor: 5.209
Authors: C Faivre-Finn; J D Fenwick; K N Franks; S Harrow; M Q F Hatton; C Hiley; J J McAleese; F McDonald; J O'Hare; C Peedell; T Pope; C Powell; R Rulach; E Toy Journal: Clin Oncol (R Coll Radiol) Date: 2020-05-13 Impact factor: 4.126