Vieri Scotti1, Alessio Bruni2, Giulio Francolini1, Marco Perna1, Polina Vasilyeva2, Mauro Loi1, Gabriele Simontacchi1, Domenico Viggiano3, Biancaluisa Lanfranchi2, Alessandro Gonfiotti3, Juljana Topulli1, Emanuela Olmetto4, Virginia Maragna1, Katia Ferrari5, Viola Bonti5, Camilla Comin6, Sara Balduzzi7, Roberto D'Amico8, Frank Lohr2, Luca Voltolini3, Lorenzo Livi1. 1. Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy. 2. Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy. 3. Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy. 4. Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy. Electronic address: e.olmetto@gmail.com. 5. Section of Respiratory Medicine, Careggi University Hospital, Florence, Italy. 6. Department of Pathology, Careggi University Hospital, Florence, Italy. 7. Department of Diagnostic, Clinical and Public Health Medicine, Modena and Reggio Emilia University Hospital, Modena, Italy. 8. Department of Maternal-Infant and Adult Medical and Surgical Sciences, Research and Innovation Area, Modena and Reggio Emilia University Hospital, Modena, Italy.
Abstract
BACKGROUND: Stereotactic ablative body radiation therapy (SBRT) has evolved as the standard treatment for patients with inoperable stage I non-small-cell lung cancer (NSCLC). We report the results of a retrospective analysis conducted on a large, well-controlled cohort of patients with stage I to II NSCLC who underwent lobectomy (LOB) or SBRT. MATERIALS AND METHODS: One hundred eighty-seven patients with clinical-stage T1a-T2bNoMO NSCLC were treated in 2 academic hospitals between August 2008 and May 2015. Patients underwent LOB or SBRT; those undergoing SBRT were sub-classified as surgical candidates and nonsurgical candidates, according to the presence of surgical contraindications or comorbidities. RESULTS: In univariate analysis, no significant difference was found in local control between patients who underwent SBRT and LOB, with a trend in favor of surgery (hazard ratio [HR], 0.27; 95% confidence interval [CI], 0.07-1.01; P < .053). Univariate analysis showed that overall survival (OS) was significantly better in patients who underwent LOB (HR, 0.44; 95% CI, 0.23-0.85) with a 3-year OS of 73.4% versus 65.2% for surgery and radiation therapy patients, respectively (P < .01). However, no difference in OS was observed between operable patients undergoing SBRT and patients who underwent LOB (HR, 1.68; 95% CI, 0.72-3.90). Progression-free survival was comparable between patients who underwent LOB and SBRT (HR, 0.61; P = .09). CONCLUSION: SBRT is a valid therapeutic approach in early-stage NSCLC. Furthermore, SBRT seems to be very well-tolerated and might lead to the same optimal locoregional control provided by surgery for patients with either operable or inoperable early-stage NSCLC.
BACKGROUND: Stereotactic ablative body radiation therapy (SBRT) has evolved as the standard treatment for patients with inoperable stage I non-small-cell lung cancer (NSCLC). We report the results of a retrospective analysis conducted on a large, well-controlled cohort of patients with stage I to II NSCLC who underwent lobectomy (LOB) or SBRT. MATERIALS AND METHODS: One hundred eighty-seven patients with clinical-stage T1a-T2bNoMO NSCLC were treated in 2 academic hospitals between August 2008 and May 2015. Patients underwent LOB or SBRT; those undergoing SBRT were sub-classified as surgical candidates and nonsurgical candidates, according to the presence of surgical contraindications or comorbidities. RESULTS: In univariate analysis, no significant difference was found in local control between patients who underwent SBRT and LOB, with a trend in favor of surgery (hazard ratio [HR], 0.27; 95% confidence interval [CI], 0.07-1.01; P < .053). Univariate analysis showed that overall survival (OS) was significantly better in patients who underwent LOB (HR, 0.44; 95% CI, 0.23-0.85) with a 3-year OS of 73.4% versus 65.2% for surgery and radiation therapy patients, respectively (P < .01). However, no difference in OS was observed between operable patients undergoing SBRT and patients who underwent LOB (HR, 1.68; 95% CI, 0.72-3.90). Progression-free survival was comparable between patients who underwent LOB and SBRT (HR, 0.61; P = .09). CONCLUSION: SBRT is a valid therapeutic approach in early-stage NSCLC. Furthermore, SBRT seems to be very well-tolerated and might lead to the same optimal locoregional control provided by surgery for patients with either operable or inoperable early-stage NSCLC.
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