Bradley G Ackerson1, Betty C Tong2, Julian C Hong1, Lin Gu3, Junzo Chino1, Jacob W Trotter1, Thomas A D'Amico2, Jordan A Torok1, Kyle Lafata1, Catherine Chang1, Chris R Kelsey4. 1. Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States. 2. Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, United States. 3. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, United States. 4. Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States. Electronic address: christopher.kelsey@duke.edu.
Abstract
PURPOSE: To compare sublobar resection and stereotactic body radiation therapy (SBRT) in patients with stage I non-small cell lung cancer (NSCLC). METHODS: Patients undergoing sublobar resection or SBRT for stage I NSCLC from 2007 to 2014 at Duke University Medical Center were evaluated. The primary endpoint of interest was freedom from local recurrence. Kaplan-Meier survival estimates and Cox proportional hazards multivariate analyses were performed. RESULTS: 221 patients with stage I NSCLC undergoing sublobar resection (n = 151; 105 wedge and 46 segmentectomy) or SBRT (n = 70) were evaluated. The majority (89%) of patients receiving SBRT were medically inoperable, and compared with surgical patients, were significantly older (74 vs 70 years, p = 0.019), had higher Charlson Comorbidity Indices (3.7 vs 2.7, p < 0.001), larger tumors (2.4 cm vs 1.7 cm, p < 0.001), and worse baseline pulmonary function. At 3 years, freedom from local recurrence was 90% (95% CI 82-94%) for surgery and 85% (95% CI 65-94%) for SBRT (p = 0.71). While overall survival and disease-free survival were higher in the surgical cohort, no differences were noted in cancer-specific disease-free survival (60% vs. 65%, p = 0.84). On multivariate analysis, higher Charlson Comorbidity Index (HR 1.38, 95% CI 1.19-1.61, p < 0.001) and lower diffusion capacity (HR 0.97, 95% CI 0.96-0.98, p < 0.001) were independently associated with inferior overall survival. No differences in overall survival between surgery and SBRT (HR 1.20, 95% CI 0.74-1.95, p = 0.46) were observed after correcting for baseline imbalances in prognostic factors. CONCLUSIONS: SBRT and sublobar resection provided similar rates of local tumor control and overall clinical outcomes in stage I NSCLC.
PURPOSE: To compare sublobar resection and stereotactic body radiation therapy (SBRT) in patients with stage I non-small cell lung cancer (NSCLC). METHODS:Patients undergoing sublobar resection or SBRT for stage I NSCLC from 2007 to 2014 at Duke University Medical Center were evaluated. The primary endpoint of interest was freedom from local recurrence. Kaplan-Meier survival estimates and Cox proportional hazards multivariate analyses were performed. RESULTS: 221 patients with stage I NSCLC undergoing sublobar resection (n = 151; 105 wedge and 46 segmentectomy) or SBRT (n = 70) were evaluated. The majority (89%) of patients receiving SBRT were medically inoperable, and compared with surgical patients, were significantly older (74 vs 70 years, p = 0.019), had higher Charlson Comorbidity Indices (3.7 vs 2.7, p < 0.001), larger tumors (2.4 cm vs 1.7 cm, p < 0.001), and worse baseline pulmonary function. At 3 years, freedom from local recurrence was 90% (95% CI 82-94%) for surgery and 85% (95% CI 65-94%) for SBRT (p = 0.71). While overall survival and disease-free survival were higher in the surgical cohort, no differences were noted in cancer-specific disease-free survival (60% vs. 65%, p = 0.84). On multivariate analysis, higher Charlson Comorbidity Index (HR 1.38, 95% CI 1.19-1.61, p < 0.001) and lower diffusion capacity (HR 0.97, 95% CI 0.96-0.98, p < 0.001) were independently associated with inferior overall survival. No differences in overall survival between surgery and SBRT (HR 1.20, 95% CI 0.74-1.95, p = 0.46) were observed after correcting for baseline imbalances in prognostic factors. CONCLUSIONS: SBRT and sublobar resection provided similar rates of local tumor control and overall clinical outcomes in stage I NSCLC.
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