Masaya Tamura1, Isao Matsumoto2, Yusuke Tanaka2, Daisuke Saito2, Shuhei Yoshida2, Seiichi Kakegawa2, Tomoyasu Kumano3, Yosuke Shimizu4, Hiroyasu Tamamura5, Tsuyoshi Takanaka6, Hirofumi Takemura2. 1. Department of Thoracic, Cardiovascular and General Surgery, Kanazawa University, Kanazawa, Japan. Electronic address: masatamu2007@yahoo.co.jp. 2. Department of Thoracic, Cardiovascular and General Surgery, Kanazawa University, Kanazawa, Japan. 3. Department of Radiotherapy, Kanazawa University, Kanazawa, Japan. 4. Department of Surgery, Fukui Prefectural Hospital, Fukui, Japan. 5. Department of Radiology, Fukui Prefectural Hospital, Fukui, Japan. 6. Department of Radiology, Asanogawa General Hospital, Kanazawa, Japan.
Abstract
BACKGROUND: The aim of this study was to compare outcomes of primary treatment with stereotactic body radiation therapy (SBRT) versus sublobar resection (SLR) for clinical stage I non-small cell lung cancer (NSCLC) in patients with medical comorbidities. METHODS: Consecutive patients who underwent SBRT (n = 106) or SLR (100 wedge resection, 41 segmentectomy) because of medical comorbidities associated with stage I NSCLC were enrolled. Lesions located in the outer third of the lung field on computed tomography were defined as external, and others were defined as internal. A propensity score-matched analysis was also performed that compared SBRT and SLR results. Charts were reviewed to determine local tumor recurrence, disease-specific survival (DSS), and overall survival (OS). RESULTS: A propensity score-matched analysis, recurrence-free survival (RFS) became significant in favor of surgery (p = 0.036). For large nodules of greater than 2.0 cm in diameter, RFS was significantly better in the surgery group (p = 0.042). No significant differences in OS, DSS, or RFS were observed with small nodules of less than 2.0 cm in diameter. In the external group, a higher recurrence rate was seen for SBRT group. For internal group, there was no statistical difference between each treatment. Local recurrence rate was higher in the SBRT group (p = 0.0082) in the external group. CONCLUSIONS: In a matched comparison of stage I NSCLC in patients with medical comorbidities, RFS was in favor of surgery comparing SBRT, but there were no significant differences in OS or DSS. The tumor size and tumor location should be considered before deciding whether to perform SBRT or surgery.
BACKGROUND: The aim of this study was to compare outcomes of primary treatment with stereotactic body radiation therapy (SBRT) versus sublobar resection (SLR) for clinical stage I non-small cell lung cancer (NSCLC) in patients with medical comorbidities. METHODS: Consecutive patients who underwent SBRT (n = 106) or SLR (100 wedge resection, 41 segmentectomy) because of medical comorbidities associated with stage I NSCLC were enrolled. Lesions located in the outer third of the lung field on computed tomography were defined as external, and others were defined as internal. A propensity score-matched analysis was also performed that compared SBRT and SLR results. Charts were reviewed to determine local tumor recurrence, disease-specific survival (DSS), and overall survival (OS). RESULTS: A propensity score-matched analysis, recurrence-free survival (RFS) became significant in favor of surgery (p = 0.036). For large nodules of greater than 2.0 cm in diameter, RFS was significantly better in the surgery group (p = 0.042). No significant differences in OS, DSS, or RFS were observed with small nodules of less than 2.0 cm in diameter. In the external group, a higher recurrence rate was seen for SBRT group. For internal group, there was no statistical difference between each treatment. Local recurrence rate was higher in the SBRT group (p = 0.0082) in the external group. CONCLUSIONS: In a matched comparison of stage I NSCLC in patients with medical comorbidities, RFS was in favor of surgery comparing SBRT, but there were no significant differences in OS or DSS. The tumor size and tumor location should be considered before deciding whether to perform SBRT or surgery.
Authors: Henry S Park; Frank C Detterbeck; David C Madoff; Brett C Bade; Ulas Kumbasar; Vincent J Mase; Andrew X Li; Justin D Blasberg; Gavitt A Woodard; Whitney S Brandt; Roy H Decker Journal: J Thorac Dis Date: 2022-06 Impact factor: 3.005
Authors: Frank C Detterbeck; Vincent J Mase; Andrew X Li; Ulas Kumbasar; Brett C Bade; Henry S Park; Roy H Decker; David C Madoff; Gavitt A Woodard; Whitney S Brandt; Justin D Blasberg Journal: J Thorac Dis Date: 2022-06 Impact factor: 3.005
Authors: Angel Cilleruelo-Ramos; Esther Cladellas-Gutiérrez; Carolina de la Pinta; Laura Quintana-Cortés; Paloma Sosa-Fajardo; Felipe Couñago; Xabier Mielgo-Rubio; Juan Carlos Trujillo-Reyes Journal: World J Clin Oncol Date: 2021-12-24